Duration Of Sensory Blockade Research Articles

A Comparitive Study of Bupivacaine 0.5% versus Ropivacaine 0.5% for Supraclavicular Brachial Plexus Block in Adult Patients

Introduction: Peripheral nerve blocks have become important in clinical practice because of their role in post-operative pain relief, shortening of patient recovery time & avoiding risks and adverse effects of general anaesthesia. Bupivacaine is a long acting local anaesthetic. Due to its long duration of action and combined with its high quality sensory blockade compared to motor blockade it has been the most commonly used local anaesthetic for peripheral nerve blocks. Ropivacaine is a newer, long acting local anaesthetic whose neuronal blocking potential used in peripheral nerve blockade seems to be equal or superior to bupivacaine. Studies show that it has significantly greater safety margin over bupivacaine. Hence here is an attempt through the study to compare bupivacaine with ropivacaine in supraclavicular brachial plexus block in adult patients. Aims and Objectives: To compare the effect of bupivacaine 0.5% & ropivacaine 0.5% used for supraclavicular approach to brachial plexus block with respect to onset time of sensory blockade, onset time of motor blockade, duration of sensory blockade, duration of motor blockade, duration of analgesia, side effects/ complications. Method of Collection of Data: Sixty patients aged between 18 years and 60 years, of physical status ASA grade 1 and ASA grade 2 undergoing elective upper limb surgeries lasting more than 30 minutes were included in the study after getting ethical clearance. Each patient was randomly allocated to one of the two groups of 30 patients each. The patients were explained about the procedure and premedicated with tab alprazolam 0.5mg, and tab ranitidine 150 mg. The anesthetic technique employed was supraclavicular brachial plexus block using 30 ml of either 0.5% bupivacaine or 0.5% ropivacaine

Prospective Randomised Study To Compare Inj Dexmedetomidine And Inj Clonidine As Adjuvant To Bupivacaine Used For Ultrasound Guided Subclavian Perivascular And Axillary Block In Upper Limb Surgeries

Background: Ultrasound continues to grow in popularity as a method of nerve localization and it has the advantage of allowing real time visualization of the plexus , pleura and vessels along with the needle and local anaesthetic spread. [4] So this study intends to compare efficacy and safety of Inj.clonidine and Inj.Dexmedetomidine as adjuvant to local anaesthetic for USG guided subclavian perivascular and axillary block in upper limb surgeries. Materials and Methods: We conducted this study as a prospective randomized study. A total of 70 adult patients were randomly selected who fulfilled the inclusion criteria. They were divided into groups and study was conducted. Results: In this study, we measured the results of each drug by its action on onset and peak of sensory and motor blockade and duration of blockade. Conclusion: From our study we conclude that both Clonidine and Dexmeditomidine with local anaesthetics promote satisfactory anaesthesia for upper limb surgeries. Onset and duration sensory blockade of clonidine group is faster and duration of sensory blockade is more than dexmeditomidine group as adjuvant to local anaesthetics in USG guided subclavian pervascular block plus axillary block.

Comparative Study of Anaesthetic Properties of Bupivacaine Alone And A Combination of Dexamethasone And Bupivacaine, for Interscalene Brachial Plexus Block, in Upper Limb Surgery

Background: Peripheral nerve blocks are used as the sole anaesthetic technique to facilitate painless surgery supplemented with monitored anaesthesia care. People have tried mixing local anaesthetic with adjuvant drugs in an attempt to prolong analgesia duration. Aims of this study is to determine the effects of dexamethasone, when added to bupivacaine on the onset, duration of sensory blockade, motor blockade and evaluated its side effects during interscalene brachial plexus block . Method : It was a randomized, double blind, interventional type, hospital based controlled study. 60 patients were randomized into two groups. In control group bupivacaine 140 mg (28 ml of 0.5 % solution) + 2 ml normal saline. In dexamethasone group bupivacaine 140 mg (28 ml of 0.5 % solution) + dexamethasone 8mg (2 ml of 4mg/ml of solution). The primary outcome was the time to first analgesic requested in post-anaesthesia care unit . Numerical variables were compared by the student’s t-test or mann-whitney U-test, depending on the distribution. Result: Dexamethasone significantly prolonged the duration of analgesia . The duration of analgesia with bupivacaine was [mean ± SD] 395+47.25 (min) and with dexamethasone and bupivacaine was 718+57.14 (min). There was significant difference between the postoperative VAS scores of the two groups at the time period of 6 hrs and 12 hrs postoperatively. In 18 hrs. and 24 hrs, there was also significant difference in onset of sensory blockade [dexamethasone(9.67 +1.12min) vs bupivacaine(12.72+1.39 min.),P vale 0.00] but there was no significant difference in onset motor and duration of motor blockade. Conclusion: Dexamethasone when added to 0.5% bupivacaine in interscalene brachial plexus block in shoulder and arm surgeries,there was in early onset and prolongation of sensory analgesia and provides better postoperative analgesia.

Randomized Clinical Comparison of Three Different Doses of Bupivacaine with Fentanyl for TURP-Search for Optimal Dose to Be Used in Day Care Urological Procedures

Background: Patients who are candidates for TURP are elderly with cardiovascular and respiratory diseases with anticipated problems during spinal anesthesia. Aim: To compare three different doses (5mg, 7.5mg and 10mg) of Bupivacaine after adding 25 mcg of fentanyl during spinal anesthesia in transurethral resection of prostate surgeries. Methods: Single blinded Randomized clinical study conducted in 75 patients. The subjects were allocated in to three groups. Group A - received Inj. 0.5% Bupivacaine 5 mg, Group B- received Inj. 0.5% Bupivacaine 7.5 mg, Group C received Inj.0.5% Bupivacaine 10 mg added with 25 mcg of Fentanyl. Baseline and intraoperative vital parameters, time to sensory block at t10, maximum sensory height, time to two segment sensory regression, total duration of sensory blockade, grading of motor blockade and total duration of motor blockade were recorded. Results: Maximum sensory level achieved in Group A was T9, Group B T7 and in Group C it was T5. Time to T10 level in Group A was 7.88 ±0.80 minutes, Group B 5.41 ±0.50 minutes and Group C 3.33 ±0.65 minutes. Two segment sensory regression times in Group A was 56.8±13.61 minutes, Group B 79.58 ±25.32 minutes, and Group C was 116.25 ±9.35 minutes. Total duration of pain free interval in Group A was 84.6 ±20.41 minutes, Group B 104.12 ±45.89 minutes. Group C was 194.20 ±41.53 minutes. Conclusion: Low dose of Bupivacaine (5mg) with addition of Fentanyl 25 μg can be used for painless TURP surgeries when compared to higher doses (7.5mg and 10 mg) without any major side effects and facilitates early discharge.

Evaluation of spinal anesthesia blockade time with 0.5% hyperbaric bupivacaine, with or without sufentanil, in chronic opioid users: a randomized clinical trial

The primary outcome of this study was to evaluate the effect of adding sufentanil to hyperbaric bupivacaine on duration of sensory blockade of spinal anesthesia in chronic opioid users in comparison with non-addicts. Sixty patients scheduled for orthopedic surgery under spinal anesthesia were allocated into four groups: group 1 (no history of opium use who received intrathecal hyperbaric bupivacaine along with 1mL saline as placebo); group 2 (no history of opium use who received intrathecal bupivacaine along with 1mL sufentanil [5μg]); group 3 (positive history of opium use who received intrathecal bupivacaine along with 1mL saline as placebo) and group 4 (positive history of opium use who received intrathecal bupivacaine along with 1mL sufentanil [5μg]). The onset time and duration of sensory and motor blockade were measured. The duration of sensory blockade in group 3 was 120±23.1min which was significantly less than other groups (G1=148±28.7, G2=144±26.4, G4=139±24.7, p=0.007). The duration of motor blockade in group 3 was 145±30.0min which was significantly less than other groups (G1=164±36.0, G2=174±26.8, G4=174±24.9, p=0.03). Addition of 5μg intrathecal sufentanil to hyperbaric bupivacaine in chronic opioid users lengthened the sensory and motor duration of blockade to be equivalent to blockade measured in non-addicts.

A comparative study of 0.5% hyperbaric Ropivacaine versus 0.5% hyperbaric Bupivacaine for spinal anaesthesia

Aims and Objective: Aim of the present study was to compare the clinical efficacy of 0.5% hyperbaric solutions of ropivacaine versus bupivacaine in terms of characteristics of spinal blockade, haemodynamic stability, recovery profile and side effects. Material and Method: The study enrolling 100 patients (age 20-60 years) of either sex, ASA grade I & II were randomly allocated in two groups. Group R received 3 ml of 0.5% hyperbaric ropivacaine with glucose 8.33% and Group B received 3 ml of 0.5% hyperbaric bupivacaine with glucose 8%. After induction, we studied the various parameters of subarachnoid block, hemodynamic variables, recovery and side effects. Result: Hyperbaric ropivacaine had late onset of sensory blockade, equal time to reach maximum dermatome level, early regression and shorter total duration of sensory blockade as compared to bupivacaine. Ropivacaine shows late onset of motor blockade, less degree and total duration of motor blockade as compared to bupivacaine. Ropivacaine was more hemodynamically stable as compared to bupivacaine. Both the sensory and motor blocks were subject to a more rapid recovery with ropivacaine compared with bupivacaine. Hyperbaric ropivacaine was not associated with any side effects intra and postoperatively. Conclusion: 3 ml of hyperbaric solution of ropivacaine 0.5% with glucose 8.33% can produce predictable and reliable spinal anaesthesia for a wide range of surgical procedure.

Preemptive Oral Clonidine Provides Better Sedation Than Intravenous Midazolam in Brachial Plexus Nerve Blocks.

BackgroundPreemptive analgesia is the blocking of pain perception afferent pathways before noxious painful stimuli. Clonidine is an alpha agonist drug that is partially selective for α-2 adrenoreceptors. Clonidine is used as anti-anxiety medication and an, analgesic, and it prolongs the duration of the block in the brachial plexus block.ObjectivesTo compare the effect of preemptive clonidine with midazolam on intraoperative sedation, duration of block, and postoperative pain scores.Patients and MethodsIn a randomized clinical trial, 80 patients with orthopedic fractures of an upper extremity who underwent supraclavicular nerve block were randomly assigned to receive 0.2 mg oral clonidine or 2 mg oral midazolam. Intraoperative sedation was measured at one hour after the start of urgery and again in the PACU (Post-Anesthesia Care Unit) using the Ramsay scale. The duration of sensory blockade was measured. Postoperative pain scores were measured using the VAS (Visual Analogue Scale) after entrance to recovery up to 2 hours.ResultsThe percentages of patients in the calm and sedated scale were significantly higher in clonidine group (35 and 42.5%, respectively), compared to the midazolam group (17.5 and 17.5%, respectively) (P = 0.042, 0.029; respectively). Those administered fentanyl in the clonidine group 105 ± 30.8 was significantly lower than that for the midazolam group 165 ± 34.5 (P = 0.0018). The percentages of patients in the calm scale were significantly higher in the clonidine group (52.5), compared to the midazolam group (17.5) (P = 0.001) in the post-operative period. VAS scores were significantly lower at one (P = 0.01) and two hours (P = 0.001) after operation in the clonidine group, compared to the midazolam group.ConclusionsPreemptive clonidine has many marvelous advantages over midazolam, including better sedation inside the operating room and then in the post-operative care unit, lower fentanyl doses are required during surgery, more stable heart rate and blood pressure are observed during the procedure, and patients report lower post-operative pain scores.

Comparing the Analgesic Efficacy of Intrathecal Bupivacaine Alone with Intrathecal Bupivacaine Midazolam or Magnesium Sulphate Combination in Patients Undergoing Elective Infraumbilical Surgery

Background.Spinal anaesthesia, which is one of the techniques for infraumbilical surgeries, is most commonly criticized for limited duration of postoperative analgesia.Aim of the Work.The aim of this study was to decrease bupivacaine dose used in spinal anesthesia in patients undergoing orthopedic lower limb surgery and reduce its possible side effects.Patient and Methods.Sixty adult patients of both sexes, divided into three.Group Creceived 2.5 mL bupivacaine and 0.5 mL saline 0.9%.Group Areceived 2.5 mL bupivacaine and 0.5 mL midazolam.Group Breceived 2.5 mL bupivacaine and 0.5 mL magnesium sulphate.Results.As regards onset of both motor and sensory blockade, there are a significant decrease in group A and a significant increase in group B as compared to group C, with a significant decrease in duration of motor blockade and significant increase in duration of sensory blockade in both group A and group B, respectively, as compared to group C, with a significant decrease in the duration of sensory blockade in group B as compared to group C.Conclusions.These results suggested that intrathecal midazolam as an adjuvant for bupivacaine increases the duration of both sensory and motor blockade more than that of magnesium sulphate.

Dexmedetomidine as an Adjuvant to Bupivacaine in Supraclavicular Brachial Plexus Block

Background: Many drugs have been used as adjuvants to local anesthetic agents to prolong the duration of peripheral nerve blocks and decrease the time of onset. In this study we assessed the effect of dexmedetomidine as an adjuvant to bupivacaine in supraclavicular brachial plexus block in terms of onset and duration of sensory and motor blockade, intraoperative sedation, postoperative analgesia, sedation and Complications /side effects if any. Methods: 60 patients of age 18-70 yrs were divided into two equal groups for upper limb surgeries under supraclavicular brachial plexus block. Group BD was given 39 millilitres (ml) of 0.5% Bupivacaine+1 microgram/kg dexmedetomidine; Group BS was given 39 ml of bupivacine+1 ml of saline. The following brachial plexus nerve block parameters were assessed hemodynamic parameters, onset and duration of sensory and motor blockade, Ramsay sedation score, verbal rating score, duration of analgesia, duration for rescue analgesia and number of analgesia given. Results: The onset of sensory blockade was 2.54 minutes less in Group (BD) when compared to Group (BS). The onset of Motor Blockade is 3.26 minutes less in Group (BD) when compared to Group (BS). The duration of sensory blockade is 195.65 minutes more in Group (BD) then Group (BS). The duration of Motor Blockade is 190.33 minutes more in Group (BD) when compared to Group (BS). The duration of Analgesia is 207.83 minutes more in Group (BD) when compared to Group (BS). Ramsay sedation score in Gp (BD)continued to show slightly higher sedation scores at all times including postoperative period in comparison to Gp (BS) (P<0.01). Conclusion: Dexmedetomidine is good adjuvant to local anesthestic agents, as its addition to bupivacaine was associated with prolonged sensory and motor blockade, mild sedation and prolonged analgesia. Satisfactory hemodynamic stability without observed immediate post-operative side effects are other significant qualities related to it.

Comparison of Effect of Intrathecal Fentanyl-bupivacaine and Tramadol-bupivacaine Combination on Postoperative Analgesia in Lower Abdominal Surgeries

ABSTRACTIntroductionThis single-center, prospective, randomized, double-blind study compares the effect of intrathecal fentanylbupivacaine and tramadol-bupivacaine on the onset and duration of sensory and motor blockade, as well as postoperative analgesia in lower abdominal surgeries.Materials and methodsPatients of either sex, aged 18 to 60 years, American Society of Anesthesiologists (ASA) grade I/II undergoing lower abdominal surgeries like appendicectomy, inguinal hernia repair surgery, and hydrocele surgery were administered either 2.5 mL of 0.5% bupivacaine + 0.5 mL (25 μg) of fentanyl citrate (group F) or 2.5 mL of 0.5% bupivacaine + 0.5 mL (25 mg) of tramadol (group T) intrathecally.Monitoring of the vital parameters, onset and duration of sensory and motor block, duration of postoperative analgesia, visual analog scale (VAS) score, sedation score, and any adverse drug reactions was done at predetermined intervals.ResultsSixty patients were randomized to the group F (n = 30) and group T (n = 30). The duration of sensory blockade was significantly prolonged in group F (314.66 ± 49.25 minutes) as compared to group T (261.66 ± 27.92 minutes). Similarly, duration of motor blockade was longer in group F (263.66 ± 40.97 minutes) compared to group T (214.66 ± 26.61 minutes). The total duration of analgesia was significantly prolonged (p &lt; 0.001) in group F (412 ± 97.888 minutes) compared to group T (301 ± 38.75 minutes).Hemodynamic parameters, such as pulse, systolic blood pressure, diastolic blood pressure and oxygen saturation were comparable in both the groups. Visual analog scores were significantly lower in the group F patients as compared to the group T patients. The group F patients had got significantly higher sedation scores as compared to Group T patients.DiscussionFentanyl 25 μg, when added to 2.5 mL of 0.5% hyperbaric bupivacaine, confers prolonged duration of sensory and motor blockade than 25 mg tramadol added to 2.5 mL of 0.5% hyperbaric bupivacaine. The bupivacaine-fentanyl combination prolonged duration of sensory and motor blockade, improved analgesia, as manifested by lower pain scores, and prolonged duration of postoperative analgesia.How to cite this articleDalvi NP, Patil N. Comparison of Effect of Intrathecal Fentanyl-bupivacaine and Tramadol-bupivacaine Combination on Postoperative Analgesia in Lower Abdominal Surgeries. Res Inno in Anesth 2016;1(2):35-40.

A Comparative Study of Addition of Midazolam to Lignocaine—Bupivacaine vs only Lignocaine— Bupivacaine in Brachial Plexus Block

ABSTRACTIntroductionThis prospective, randomized, double-blind study compared the onset and duration of sensory blockade, motor blockade, and analgesia with lignocaine, bupivacaine, and midazolam combination vs only lignocaine, bupivacaine in brachial plexus block.Materials and methodsPatients of either sex, aged 18–60 years, American Society of Anesthesiologists grade I/II, posted for upper limb surgeries to be performed under supraclavicular brachial plexus block with the help of peripheral nerve stimulator were administered either 10 ml 0.5% bupivacaine with 50 μg/kg midazolam (preservative free) + 20 ml 2% lignocaine with adrenaline (1:200,000) in Group lignocaine– bupivacaine–midazolam (LBM) or 10 ml 0.5% bupivacaine + 20 ml 2% lignocaine with adrenaline (1:200,000) in Group lignocaine–bupivacaine (LB).Onset and duration of sensory and motor blockade were monitored. Postoperative analgesia was graded with visual analog scale. Sedation was monitored with Ramsey sedation score.ResultsA total of 60 patients were randomized to the group LBM (n = 30) and group LB (n = 30). The analgesia was significantly prolonged in the study group, with a mean of 11.72 ± 1.924 hours as compared with a mean of 6.383 ± 1.031 hours in the control group. Sedation scores were higher in the study group, that is, group LBM compared to group LB postoperatively.ConclusionIn conclusion, midazolam when added to bupivacaine and adrenalized lignocaine for supraclavicular brachial plexus block hastens the onset of sensory and motor blockade. This combination improves analgesia, as manifested by lower pain scores and prolonged duration of analgesia.How to cite this articleDalvi NP, Salunkhay H, Mohite SN. A Comparative Study of Addition of Midazolam to Lignocaine–Bupivacainevsonly Lignocaine–Bupivacaine in Brachial Plexus Block. Res Inno in Anaesth 2016;1(1):5-9.

Effect of intrathecal clonidine versus fentanyl on bupivacaine spinal block in transurethral resection of prostate surgeries.

Aims:Our study aimed at comparing the onset, degree and recovery time of sensory and motor block, the hemodynamic effects and postoperative pain relief using intrathecal bupivacaine alone, bupivacaine along with fentanyl and clonidine.Materials and Methods:A total of 90 patients, undergoing transurethral resection of prostate (TURP) surgeries under spinal anesthesia were studied. Patients were randomly divided in a double-blind manner into three groups of 30 patients each. Group A (control) patients given subarachnoid block with 0.5% hyperbaric bupivacaine with 0.5 ml of normal saline. Group B patients were given subarachnoid block with 0.5% hyperbaric bupivacaine along with fentanyl 25 μg. Group C patients were given subarachnoid block with 0.5% hyperbaric bupivacaine 10 mg along with clonidine 30 μg and 0.3 ml of normal saline. After administering the subarachnoid block, vitals were recorded before and after surgery. Level of sensory block, the duration of motor block (DOMB), duration of sensory blockade (DOSB), the quality of postoperative analgesia using linear visual analog scale (VAS), and side effects were evaluated.Results:The time required to attain a maximum height of the block was significantly more in Group B as compared to Groups A and C, which was statistically significant. However, there was no statistically significant difference between Groups A and C. The mean DOSB in Groups A, B, and C were 90.83 ± 9.48 min, 135.33 ± 12.59 min, and 155.17 ± 17.49 min, respectively. The mean DOMB in Groups A, B, and C were 83.83 ± 6.52 min, 115.50 ± 14.70 min and 120.67 ± 11.50, respectively. Time of the first request of analgesia in Groups A, B and C in postoperative period were 132.50 ± 21.53 min, 296.00 ± 50.07 min, and 311.83 ± 65.34 min. patients had. VAS was significantly of higher value in Group A than Groups B and C.Conclusions:Intrathecal clonidine in a combination of bupivacaine for TURP provides more satisfactory anesthesia and analgesia and has less side effects.

Comparison of unilateral spinal anaesthesia using low dose bupivacaine with or without fentanyl in lower limb surgery

Background: Intrathecal opioids are synergistic with local anesthetics and intensifies sensory block without increasing motor block. This combination makes it possible to achieve spinal anesthesia without hemodynamic instability and adverse effects that are associated with higher doses of bupivacaine. Hence we conducted this comparative study using 5 mg of hyperbaric bupivacaine with or without fentanyl (25 µg) in unilateral spinal anaesthesia for lower limb surgery. Methods: Sixty patients were randomized into two groups with Group B receiving 0.5% bupivacaine and Group BF receiving 0.5% bupivacaine + 25 µg fentanyl intrathecal. Sensory and motor block quality and duration, post anesthesia care unit stay (PACU) and adverse effects were compared. Results: The onset of sensory block (6.17±1.44) was faster in Group B compared Group BF (6.73±1.52) and duration of sensory blockade was intensified by addition of intrathecal fentanyl in Group BF. The onset and duration of motor blockade was similar in both the groups and was not affected by addition of fentanyl in Group BF. The number and mean duration stay in PACU was found to be significantly higher in patients 24 [80%]; 30 minutes receiving fentanyl suggesting it prolonged duration of recovery. No patient in either group had hypotension, respiratory depression, sedation, nausea, vomiting, PDPH and TNS. Only 1 patient in each group experienced bradycardia and 4 patients in Group BF had mild pruritus. Conclusions: Unilateral spinal anaesthesia with 5 mg hyperbaric bupivacaine with 25 µg fentanyl is a better choice than 5 mg hyperbaric bupivacaine alone in short procedure of lower limb in orthopaedic surgery.

Ifenprodil for prolonged spinal blockades of motor function and nociception in rats.

The aim of the study was to compare the proposed spinal anesthetic effect of ifenprodil, an a1 adrenergic receptor antagonist, with that of the long-acting local anesthetic bupivacaine. After intrathecally injecting the rats with five different doses of each drug, the dose-response curves of ifenprodil and bupivacaine were constructed to obtain the 50% effective dose (ED50). The spinal blockades of motor function and nociception of ifenprodil were compared with that of bupivacaine. We showed that either ifenprodil or bupivacaine produced spinal blockades of motor function and nociception dose-dependently. On the ED50 basis, the potency of ifenprodil (0.42(0.38-0.46) μmol; 0.40(0.36-0.44) μmol) was equal (p>0.05) to that of bupivacaine (0.38(0.36-0.40) μmol; 0.35(0.32-0.38) μmol) in motor function and nociception, respectively. At the equianesthetic doses (ED25, ED50, and ED75), duration produced by ifenprodil was greater than that produced by bupivacaine in motor function and nociception (p<0.05 for the differences). Furthermore, both ifenprodil and bupivacaine showed longer duration of sensory blockade than that of motor blockade (p<0.05 for the differences). The resulting data demonstrated that ifenprodil produces a dose-dependent local anesthetic effect in spinal anesthesia. Ifenprodil shows a more sensory-selective duration of action over motor block, whereas the duration of anesthesia is significantly longer with ifenprodil than with bupivacaine.

Evaluation of spinal anesthesia blockade time with 0.5% hyperbaric bupivacaine, with or without sufentanil, in chronic opioid users: a randomized clinical trial

ObjectiveThe primary outcome of this study was to evaluate the effect of adding sufentanil to hyperbaric bupivacaine on duration of sensory blockade of spinal anesthesia in chronic opioid users in comparison with non-addicts. MethodsSixty patients scheduled for orthopedic surgery under spinal anesthesia were allocated into four groups: group 1 (no history of opium use who received intrathecal hyperbaric bupivacaine along with 1mL saline as placebo); group 2 (no history of opium use who received intrathecal bupivacaine along with 1mL sufentanil [5μg]); group 3 (positive history of opium use who received intrathecal bupivacaine along with 1mL saline as placebo) and group 4 (positive history of opium use who received intrathecal bupivacaine along with 1mL sufentanil [5μg]). The onset time and duration of sensory and motor blockade were measured. ResultsThe duration of sensory blockade in group 3 was 120±23.1min which was significantly less than other groups (G1=148±28.7, G2=144±26.4, G4=139±24.7, p=0.007). The duration of motor blockade in group 3 was 145±30.0min which was significantly less than other groups (G1=164±36.0, G2=174±26.8, G4=174±24.9, p=0.03). ConclusionsAddition of 5μg intrathecal sufentanil to hyperbaric bupivacaine in chronic opioid users lengthened the sensory and motor duration of blockade to be equivalent to blockade measured in non-addicts.

Supraclavicular brachial plexus block using ropivacaine alone or combined with dexmedetomidine for upper limb surgery: A prospective, randomized, double-blinded, comparative study

BackgroundDexmedetomidine is a new α2 receptor agonist with analgesic and sedative properties. We used dexmedetomidine along with ropivacaine for supraclavicular brachial plexus block. MethodsEighty ASA grade I–II patients, 18–60 years old, scheduled for elective upper limb orthopaedic surgery under supraclavicular brachial plexus block, were included in this prospective study. The patients were randomly assigned to group R (ropivacaine alone) and group RD (ropivacaine and dexmedetomidine) (40 patients in each group). Group R received ropivacaine 0.50% (30 cc)+placebo and group RD received ropivacaine 0.50% (30 cc)+dexmedetomidine 1μg/kg. Primary outcome measure was duration of analgesia. Secondary measures were onset and duration of sensory blockade, pain scores, onset and duration of motor blockade, and evidence of any adverse drug reactions. ResultsThere was no significant difference haemodynamic parameter during intra-operative period. Group RD showed a statistically significant shorter time to onset of sensory blockade (10.75±2.71 vs. 16.75±2.96min, p=0.003), longer sensory block duration (379.40±55.09 vs. 211.60±47.88min, p=0.002), shorter onset time to motor blockade (14.35±2.58 vs. 20.25±4.13min, p=0.003), longer motor block duration (312.0±49.91 vs. 184.7±36.76min, p=0.002), longer duration of postoperative analgesia (413.73±89.92 vs. 197.35±28.67min, p=0.002). Three patients in the group RD developed somnolence (p=0.04). ConclusionDexmedetomidine along with ropivacaine decreases the onset of motor and sensory block and increases the duration of sensory and motor block in supraclavicular brachial plexus block.

Bloqueo supraclavicular del plexo braquial con ropivacaína sola o en combinación con dexmedetomidina en cirugías de extremidades superiores: ensayo comparativo, prospectivo, monitorización y con doble enmascaramiento

BackgroundDexmedetomidine is a new α-2 receptor agonist with analgesic and sedative properties. We used dexmedetomidine along with ropivacaine for supraclavicular brachial plexus block. MethodsEighty ASA grade I-II patients, 18-60 years old, scheduled forelective upper limb orthopaedic surgery under supraclavicular brachial plexus block, were included in this prospective study. The patients were randomly assigned to group R (ropivacaine alone) and group RD (ropivacaine and dexmedetomidine) (40 patients in each group). Group R received ropivacaine 0.50% (30cc)+placebo and group RD received ropivacaine 0.50% (30cc)+dexmedetomidine 1μg/kg. Primary outcome measure was duration of analgesia. Secondary measures were onset and duration of sensory blockade, pain scores, onset and duration of motor blockade, and evidence of any adverse drug reactions. ResultsThere was no significant difference hemodynamic parameter during intra-operative period. Group RD showed a statistically significant shorter time to onset of sensory blockade (10.75±2.71 vs. 16.75±2.96min, P=.003), longer sensory block duration (379.40±55.09 vs. 211.60±47.88min, P=.002), shorter onset time to motor blockade (14.35±2.58 vs. 20.25±4.13min, P=.003), longer motor block duration (312.0±49.91 vs. 184.7±36.76min, P=.002), longer duration of postoperative analgesia (413.73±89.92 vs. 197.35±28.67min, P=.002). Three patients in the group RD developed somnolence. (P=.04). ConclusionDexmedetomidine along with ropivacaine decreases the onset of motor and sensory block and increases the duration of sensory and motor block in supraclavicular brachial plexus block.

Chlorpheniramine produces spinal motor, proprioceptive and nociceptive blockades in rats

This study aimed to assess the local anesthetic effects of chlorpheniramine in spinal anesthesia and is compared with mepivacaine, a widely-used local anesthetic. Spinal anesthesia with chlorpheniramine and mepivacaine was constructed in a dosage-dependent fashion after the rats were injected intrathecally. The spinal block effect of chlorpheniramine in motor function, nociception, and proprioception was compared to that of mepivacaine. We revealed that intrathecal chlorpheniramine and mepivacaine exhibited a dose-dependent spinal block of motor function, nociception, and proprioception. On the 50% effective dose (ED50) basis, the ranks of potencies in motor function, nociception, and proprioception were chlorpheniramine>mepivacaine (P<0.01 for the differences). On the equianesthetic basis (ED25, ED50, ED75), the duration of spinal anesthesia with chlorpheniramine was greater than that of mepivacaine (P<0.01 for the differences). Instead of mepivacaine, chlorpheniramine produced a greater duration of sensory blockade than the motor blockade. These preclinical data showed that chlorpheniramine has a better sensory-selective action over motor block to produce more potent and long-lasting spinal anesthesia than mepivacaine.

A prospective randomized controlled study comparing intrathecal bupivacaine combined with fentanyl and sufentanil in abdominal and lower limb surgeries.

Background:Hyperbaric bupivacaine along with either fentanyl or sufentanil as additive, has been widely used in spinal anesthesia. In the present study, we compared the analgesic effects of intrathecal fentanyl versus sufentanil combined with bupivacaine for surgical procedures over the abdomen and lower limbs.Settings and Design:This was randomized controlled study conducted in a tertiary care hospital attached to a medical school.Methods:Sixty American Society of Anesthesiologists I and II patients were randomized into three groups by sealed envelope technique. Group 1 was to receive bupivacaine with fentanyl; group 2 to receive bupivacaine with sufentanil and group 3 to receive bupivacaine with saline (control), intrathecally. The parameters checked were hemodynamic changes, onset and duration of sensory block, duration of analgesia and maximal sensory level achieved.Statistical Analysis:The data collected were analyzed using χ2 test and paired Student's t-test.Results:The time taken for the onset of analgesia was longest in the control group followed by fentanyl group. The earliest onset of action of 9.35 ± 1.92 min was recorded in sufentanil group. Duration of sensory blockade and analgesia was longest for fentanyl group than the other groups. Adverse effects noted were more for sufentanil group but were self-limiting.Conclusion:Fentanyl with bupivacaine produced prolonged analgesia and delayed two-segment regression and demonstrated reduced incidence of complications as compared with intrathecal sufentanil. As the quality of analgesia was complete and comparable, fentanyl emerges as a better option for analgesia and it is much economical too when compared to sufentanil.

Comparison of dexmedetomidine and clonidine as an adjuvant to ropivacaine for epidural anesthesia in lower abdominal and lower limb surgeries.

Background:The quality and duration of analgesia is improved when a local anesthetic is combined with alpha 2 adrenergic agonist. Though, the effects of clonidine on local anesthetics have been extensively studied, there are limited studies demonstrating the effects of epidural dexmedetomidine on local anesthetics. The aim of our study is to compare the effect of clonidine and dexmedetomidine when used as an adjuvant to epidural ropivacaine in lower abdominal and lower limb surgeries.Materials and Methods:Patients were randomized into two groups-group ropivacaine with clonidine (RC) received 15 ml of 0.75% ropivacaine with 1 μg/kg clonidine and group ropivacaine with dexmedetomidine (RD) received 15 ml of 0.75% ropivacaine with 1 μg/kg dexmedetomidine epidurally. Onset of sensory analgesia using cold swab, onset of motor blockade using Bromage scale, time to 2 dermatome regression of sensory level, time to first demand for analgesia, sedation using Ramsay sedation scale, intra operative hemodynamic parameters and complications were assessed.Results:The onset (RD-8.53 ± 1.81, RC-11.93 ± 1.96) and duration of sensory blockade (RD-316 ± 31.5, RC-281 ± 37, sedation were found to be significantly better in the dexmedetomidine group. No significant difference was found in terms of onset of motor blockade and hemodynamic changes.Conclusion:Dexmedetomidine at doses of 1 μg/kg is an effective adjuvant to ropivacaine for epidural anesthesia, which is comparable to clonidine.