Duration Of Spinal Anesthesia Research Articles

Comparison of Duration of Action in Spinal Anesthesia of 0.5% Bupivacaine and 0.5% Bupivacaine with Dexmedetomidine

Background: Spinal anesthesia is a common technique for surgeries below the navel, utilizing bupivacaine, a local anesthetic. Adding adjuncts like dexmedetomidine may enhance the efficacy and duration of the block.Objective: To compare the duration of action of 0.5% bupivacaine versus 0.5% bupivacaine with dexmedetomidine in spinal anesthesia.Methods: This quasi-experimental trial included 60 patients aged 20-60 years, ASA grade 1 or 2, undergoing general, plastic, orthopedic, or urological surgery at CMH Karachi. Patients were non-randomly assigned to Group B (0.5% bupivacaine, n=30) or Group BD (0.5% bupivacaine plus 5 mcg dexmedetomidine, n=30). Onset and duration of sensory and motor blocks, duration of analgesia, and adverse effects were recorded. Data were analyzed using SPSS version 25, with a p-value ≤ 0.05 considered significant.Results: Group BD showed faster onset of sensory block (7.08 ± 0.54 mins vs. 13.48 ± 0.73 mins, p < 0.001) and motor block (10.32 ± 0.91 mins vs. 17.55 ± 0.69 mins, p < 0.001). Duration of motor block was longer in Group BD (284.06 ± 5.64 mins vs. 133.93 ± 5.72 mins, p < 0.001), as was duration of analgesia (218.07 ± 4.86 mins vs. 125.36 ± 5.42 mins, p < 0.001).Conclusion: The addition of dexmedetomidine to 0.5% bupivacaine significantly enhances the onset and duration of spinal anesthesia with a comparable safety profile.

A comparative study to assess the effects of intrathecal fentanyl and intrathecal tramadol combined with 0.5% bupivacaine heavy in patients undergoing elective urological surgeries: A prospective randomized study

Background: Urological operations frequently involve the use of spinal anesthesia. In the present scenario, adding different adjuvants to local anesthetic improve its quality and duration has become common. Aims and Objectives: In patients undergoing elective urological procedures, the purpose of this study was to assess the effects of intrathecal fentanyl or tramadol with 0.5% bupivacaine heavy. Materials and Methods: Patients were divided into two groups of 30 patients each, a total of 60 patients aged 20–60 years undergoing elective urological surgeries participated in this prospective, randomized study in which 25 μg fentanyl and 2.5 mL of 0.5% bupivacaine heavy were given to Group F, while 25 mg tramadol and 2.5 mL of 0.5% bupivacaine heavy were given to Group M. The onset and duration of sensory and motor blockage, the duration of analgesia, post-operative Visual Analog Scale score, hemodynamic changes, and adverse effects were evaluated. Results: Fentanyl had a lower mean time of onset for sensory (2:33±0:22 min vs. 4:50±0:33 min) and motor block (3:36±0:28 min vs. 5:52±0:38 min) (P<0.001), the duration of sensory (185.67±3.155 min vs. 152.60±4.264), motor block (172.00±4.177 min vs. 136.40±5.575 min), and post-operative analgesia was longer in the fentanyl group (P<0.001), whereas the incidence of adverse effects such as pruritus, shivering, and nausea was lower in the tramadol group. Conclusion: The quality and duration of spinal anesthesia were found to be significantly increased by the use of fentanyl as an adjuvant in our study. However, tramadol also produced stable hemodynamics and exhibited fewer adverse effects than fentanyl.

Comparison of Two Different Dexmedetomidine Doses and Their Effect on the Duration of Spinal Anesthesia in Lower Limb Amputation Surgeries

Abstract Background Spinal anesthesia is a very common technique used in lower limb surgeries. Dexmedetomidine is a highly selective α2-adrenergic agonist which has been used as pre-medication and as an adjuvant to general anesthesia. It is found that injection of dexmedetomidine intrathecally prolongs both sensory and motor block and has antinociceptive action for both visceral and somatic pain by depressing the release of nociceptive C fibers transmission and hyperpolarization of post synaptic dorsal horn cells. Objective To compare the effect of addition of different doses of dexmedetomidine to bupivacaine on the duration of spinal anesthesia, quality of block, intraoperative and postoperative complications and postoperative analgesia in patients undergoing lower limb amputation surgeries. Methods This prospective double blind randomized controlled clinical trial was done on sixty six adult patients of both sexes, aging from 21 to 60 years old, ASA I and II presented to Ain Shams University Hospitals for lower limb amputation surgeries were involved in this study during the period from July 2021 till May 2022. Results The addition of dexmedetomidine to bupivacaine in spinal anesthesia significantly prolonged both sensory and motor blockades duration compared with bupivacaine alone. It was significantly faster in group B (2.1 ± 0.124) compared with A and C groups (2.64 ± 0.34) and (4.72± 0.31) respectively and in group A compared with group C. They also prolonged the time of postoperative analgesia as evidenced by significantly longer time to first rescue analgesia Time to first call for rescue analgesia was significantly longer in group B (350 ± 45 mins) compared with A(287.41 ± 40.83 mins) and C(192 ± 42 mins) groups and in group B compared with group A. Also, there was significant difference in number of analgesic doses in group B compared to A and C groups and in group B compared to group A. Lower VAS scores with minimal adverse effects and hemodynamic stability. Comparing two different doses of dexmedetomidine showed that 15μg dexmedetomidine caused more prolongation of the spinal block duration and the time of postoperative analgesia than dexamethasone. It also decreased shivering during spinal anesthesia with only 4 patients compared to group A with 8 patients and group C with 9 patients. Conclusion 5μg dexmedetomidine seems to be an attractive as an adjuvant to spinal bupivacaine in surgical procedures. It provided good quality of intraoperative analgesia, hemodynamically stable conditions, minimal side effects, and excellent quality of postoperative analgesia. Unfortunately, it had not any effect on incidence or severity of phantom pain and sensation in lower limb amputation surgery, but 15μg had better time of analgesia and longer time till the patient needed rescue analgesia with lower VAS score with no remarkable difference in the side effect as revealed.

Intravenous Dexamethasone versus intrathecal Dexamethasone in Prolonging the Duration of Spinal Anesthesia and Postoperative Analgesia in Elective Cesarean Section

Abstract Background Spinal anesthesia is the most commonly used technique for cesarean section as it is very economical and easy to administer. The short duration of action of local anesthetic drugs has created a matter of concern for anesthesiologists. Aim of the Work To compare the efficacy of intrathecal dexamethasone with intravenous dexamethasone as an adjuvant to prolong the sensory block obtained by spinal anesthesia and postoperative analgesia in cesarean section. Participants and Methods 66 pregnant women scheduled for cesarean section were randomly allocated to one of three groups including (22) patients each. All the patients received injection of heavy bupivacaine 0.5% 10 mg through spinal anesthesia, with adding 1 mL of 0.9% saline and normal saline 2 mL intravenously (control group), or 0.5 mL (2mg) dexamethasone diluted in 0.5 ml of 0.9% saline intrathecally with normal saline 2 mL intravenously (IT group ), or dexamethasone 2 mL (8mg) intravenously with intrathecal injection of heavy bupivacaine 0.5% 2 mL plus 1 mL of 0.9% saline (IV group ) with overall 3 ml volume intrathecally in each group. Duration of sensory block, postoperative analgesia, visual analog pain scale (VAS) score, time of rescue analgesia in the first 24 h, intra- and post-operative hemodynamics, and side effects if any were recorded. Results The study groups, There was significantly higher post-operative analgesic duration (8.73 ± 2.64) hours compared to addition of Intravenous Dexamethasone (4.91 ± 1.02) hours or using hyperbaric bupivacaine alone (3.43 ± 0.71) hours with p-value <0.001. There was no effect on the time of onset of sensory block with no significant complications were detected. Conclusion The addition of 2mg dexamethasone intrathecally as an adjuvant to spinal anesthesia during cesarean section prolong the duration of sensory block and postoperative analgesia.

The effect of adding epinephrine on the duration of spinal anaesthesia for patients undergoing total knee replacement

The effect of adding epinephrine on the duration of spinal anaesthesia for patients undergoing total knee replacement

Comparison of the effect of intraoperative dexmedetomidine versus ketamine on postoperative analgesia in fracture femur patients operated under subarachnoid block – A prospective randomized double-blind controlled trial

Abstract Background and Aims: Intravenous sedation during spinal anesthesia has the advantages of increased duration of spinal anesthesia and better postoperative pain control. The aim of this study was to compare the effect of intravenous bolus and infusion of dexmedetomidine versus ketamine given intraoperative on the postoperative analgesia in fracture femur patients operated under subarachnoid block. Material and Methods: In this prospective randomized double-blind controlled study, 75 patients aged 18–65 years posted for elective surgery were selected and randomly divided into three groups to receive ketamine (group K), dexmedetomidine (group D), and saline (control group C). Postoperative pain was evaluated using the numerical rating scale (NRS). The duration of analgesia and the amount of analgesic consumption were also recorded. Student’s t-test and Chi-square test were used to compare the two groups, and one-way ANOVA with posthoc analysis was performed for comparison of the three groups. Results: Patients in the ketamine group had better postoperative analgesia as assessed by decreased pain (on the NRS scale) and decreased need for postoperative rescue analgesics (P < 0.001). The duration of sensory block and motor block was prolonged in group K as compared to the other two groups (P < 0.001). Conclusion: Intraoperative use of intravenous ketamine was superior to dexmedetomidine for postoperative analgesia in fracture femur patients operated under subarachnoid block.

Effects of Ketamine and Tramadol As Adjuvants to Bupivacaine in Spinal Anesthesia for Unilateral Open Ovarian Cystectomy: A Randomized Controlled Trial.

Spinal anesthesia offers numerous advantages and desirable features. However, it is associated with various side effects related to local anesthetic agents used. Reducing the dose of local anesthetic in spinal anesthesia can help minimize side effects but may lead to a diminished analgesic effect or failure of anesthesia. Therefore, adding an adjuvant may enhance the benefits while mitigating side effects. This study aimed to evaluate the effects of ketamine and tramadol as adjuvants to bupivacaine on the duration of spinal analgesia. The objectives were to compare the three groups and prove their analgesic effects, safety, and superiority.The primary outcomes werethe duration of spinal analgesia, as well as the onset and duration of both sensory and motor blocks. Secondary outcomes included the heart rate, mean arterial pressure, and the incidence of undesired effects such as nausea, vomiting, sedation, shivering, and postoperative headache. In this double-blind randomized controlled trial, 120 female patients undergoing elective open unilateral ovarian cystectomy under spinal anesthesia were studied. The inclusion criteria included patients aged 16-45 years with a physical status classified as American Societyof Anesthesiologists (ASA) class I and II. Patients were randomly allocated into three groups: group B (n=40) received only bupivacaine, group BK (n=40) received bupivacaine mixed with preservative-free ketamine, and group BT (n=40) received bupivacaine mixed with preservative-free tramadol. The mean duration of spinal analgesia, measured in minutes, showed significant differences (P < 0.001) between group BK (165 ± 4) and group B (170 ± 5). There was also a significant difference between group BT (313 ± 8) and group B (170 ± 5) (P < 0.001). Additionally, significant differences were observed between group BK (165 ± 4) and group BT (313 ± 8) (P < 0.001). The administration of 25 mg of ketamine and 25 mg of tramadol as adjuvants to bupivacaine in spinal anesthesia significantly affected the postoperative duration of analgesia. Tramadol prolonged the duration of spinal anesthesia, while ketamine shortened it. The use of both adjuvants did not result in undesired effects.

The duration of spinal anaesthesia in elective caesarean section in Trendelenburg and reverse Trendelenburg positions: a randomized clinical trial.

One of the common methods of anaesthesia for caesarean sections (CSs) involves the use of spinal anaesthesia in mothers. Various positions are utilized in this method. This study aims to compare the evaluation of two positions, Trendelenburg and reverse Trendelenburg, in candidates for CS to assess the duration of anaesthesia and changes in vital signs in women. This study was a randomized clinical trial in which 60 pregnant mothers who met the inclusion criteria entered the study. These mothers were randomly allocated into two equal groups using block randomization. One group of patients received spinal anaesthesia in the Trendelenburg position, while the other group received it in the Reverse Trendelenburg position. Vital signs (systolic and diastolic blood pressure, heart rate, Apgar score, and SPO2) of participants from both groups were evaluated for 1 h after the induction of anaesthesia. Additionally, sensory level and duration of anaesthesia were measured. Finally, the data from both groups were subjected to statistical analysis using SPSS version 26 software. The mean (SD) age of participating mothers in the Reverse Trendelenburg and Trendelenburg groups was 28.93 (5.82) and 30.97 (4.94), respectively. The two study groups did not significantly differ in baseline characteristics such as age, BMI, which could potentially impact vital sign outcomes or anaesthesia duration, and education (P>0.05). The mean (SD) duration of anaesthesia in the Trendelenburg position was significantly higher than in the Reverse Trendelenburg position [221.57(min) vs. 159.00(min)] (P<0.0001). There was no significant difference between the two positions, Trendelenburg and Reverse Trendelenburg, in terms of sensory level and its extent (P=0.08). The two study groups did not significantly differ in hemodynamic changes measured 13 times, including heart rate, systolic and diastolic blood pressure, and Apgar score (P>0.05). In spinal anaesthesia with the Trendelenburg position compared to the Reverse Trendelenburg position, there is a longer duration of anaesthesia. This is while the two positions did not differ in terms of hemodynamic changes and sensory level.

Whole-course application of dexmedetomidine as an adjuvant to spinal-epidural anesthesia for cesarean section: A randomized, controlled trial

BackgroundDexmedetomidine is known to prolong the analgesic duration of spinal anesthesia, but it can be challenging to achieve further extension without opioids. Therefore, this study aimed to investigate a novel analgesic strategy using dexmedetomidine as an adjuvant to spinal-epidural anesthesia for elective cesarean surgery. MethodsThe study was a randomized, double-blind, controlled trial conducted at a single center. Sixty parturients who underwent elective cesarean were randomly assigned to either group C or group D. Group D received an intrathecal injection of 12.5 mg ropivacaine and 5 μg dexmedetomidine followed by continuous epidural patient-controlled analgesia (PCA) infusion with a total volume of 100 ml, containing 0.2 % ropivacaine and 0.5 μg/kg dexmedetomidine. Group C received an intrathecal injection of 12.5 mg ropivacaine with an equivalent saline placebo followed by a similar PCA infusion, containing 0.2 % ropivacaine and an equivalent saline placebo. ResultsThe primary outcome was visual analog scale score on movement at 24 h after surgery. The results showed that the rest and motion pain scores in group D were significantly lower than those in group C at 6 h, 12 h, and 24 h after surgery (P < 0.05), with the differences at 24 h were 5.0 (5.0, 5.0)in group D versus 5.0 (5.0, 6.0) in group C (P = 0.04). Additionally, the time to the first PCA in group D was significantly longer than that in group C (P < 0.05), as well as the time of sensory and motor recovery. ConclusionsWhole-course application of dexmedetomidine as an adjuvant to spinal-epidural anesthesia could effectively extend the analgesic duration of ropivacaine to 24 h following elective cesarean surgery.

Prolonged duration of spinal anesthesia with normal dose of hyperbaric bupivacaine: case report

Background: Spinal anesthesia has been used for over 120 years as a relatively safe and effective method technique. A well-known anesthetic, bupivacaine is the most widely used local anesthetic in the subarachnoid space. We report a case of prolonged sensory and motor blockade in a patient undergoing spinal anesthesia with 15 mg of 0.5% hyperbaric bupivacaine without any adjuvant, which lasted 32 hours to regress. Case Report: The patient was a 36‑year‑old female, obese, with no known comorbidities, who was undergoing surgical treatment of varicose veins of the lower limbs. Normal pre-operative exams. After sedation with midazolam 2.5 mg, the patient was in a sitting position and 3 attempts at subarachnoid puncture with a 27G cutting needle were unsuccessful. Another attempt with a 25G cutting tip needle was successful and injected 15 mg of 0.5% hyperbaric bupivacaine without adjuvants. The surgical procedure lasted 3 hours without cardio circulatory changes, and the patient was referred to PACU. Ten hours after the persistence of sensory and motor blocks. MRI of the thoracolumbar spine was performed without evidence of alteration. After 17 hours, both sensory and motor blocks remained, requiring bladder catheterization. After 23 hours, the neurological examination was normal, showing the permanence of both blocks. The complete return of sensory and motor blocks occurred after 32 hours, with hospital discharge in 4 hours, after complete regression of the subarachnoid block. Conclusions: In conclusion, an unexpectedly prolonged spinal block can be seen with regular doses of 0.5% hyperbaric bupivacaine. We cannot determine the exact etiology in our present case, with a normal MRI thoracolumbar.

The Effect of Preoperative Gabapentin on the Duration of Spinal Anaesthesia in Patients Undergoing Lower Limb Surgery: A Randomized Controlled Clinical Trial

Background: In the present study, we aim to examine oral gabapentin efficacy as an adjuvant to spinal anesthesia. Methods: This prospective, clinical, randomized trial included subjects between 20 and 60 years undergoing lower limb surgeries categorized into two cohorts. Group (G) received gabapentin (900 mg) in two divided doses prior to spinal anesthesia; (300 mg 10 hrs prior to spinal anesthesia induction as well as 600 mg 2 hrs before spinal anesthesia). In contrast, the control Group (C) received only spinal anesthesia. The onset, as well as the duration of spinal anesthesia, were the primary outcome, while the secondary outcome was the postoperative nalbuphine consumed. Results: A total of 60 cases were evenly categorized into two cohorts. Both groups demonstrated no differences regarding motor and sensory block onset and duration. The group receiving preoperative gabapentin had a significant decrease in postoperative nalbuphine consumption with a mean of 20.8±9.4 mg compared to the control group, which showed an increased consumption of 28.9±10.4 mg with a p-value of 0.006. Further analysis of the Visual Analog Score (VAS) in both groups revealed that the decrease in total nalbuphine consumption was found at (8 and 10 hrs) postoperatively, with p values of 0.016 and 0009, respectively. Conclusion: Gabapentin administration (900 mg) within 10 hrs of surgery in two subdivided doses prior to spinal anesthesia had no effect on onset and duration of spinal anesthesia but had a delayed beneficial postoperative analgesic effect. Clinical Trial Registration Number: This trial was registered at ClinicalTrials.gov (NCT05659810, URL: https://clinicaltrials.gov/ct2/show/NCT05659810in 21st December 2022.

Comparison of the Sedative Effects of Intravenous Midazolam with Intravenous Dexmedetomidine and Duration of Spinal Anesthesia with Bupivacaine During Cesarean Section: A Randomized Double-Blinded Trial

Background: Caesarean section (CS) is a common procedure, and spinal anesthesia is a safe method for inducing anesthesia during this procedure. The disadvantages of this technique are intraoperative pain sensation, the patient’s fear of injection, and remembering surgery. Objectives: The purpose of this study was to compare the effects of intravenous midazolam with intravenous dexmedetomidine on sedation and duration of spinal anesthesia during CS. Methods: In this study, 70 parturients with ASA II were randomly divided into two groups of 35. All parturients underwent spinal anesthesia. One of the groups (i.e., group D) received intravenous dexmedetomidine, and for the other group (i.e., group M), midazolam was injected intravenously. The parturients were compared in terms of the pain score measured by visual pain scoring (VAS), duration of anesthesia, sedation, and hemodynamic stability. Results: The mean pain score in group M was significantly higher than in group D (P &lt; 0.001). The time to the first rescue analgesia was significantly higher in group D than in group M (P &lt; 0.001). Also, the dose of the analgesic used in the postoperative period was significantly lower in group D (P &lt; 0.001). No significant difference was found between the two groups in terms of sedation and hemodynamic status. Conclusions: The use of dexmedetomidine in comparison with midazolam resulted in longer bupivacaine-induced spinal anesthesia and duration of analgesia during and after CS, suggesting this method as an appropriate strategy for establishing an appropriate level of intraoperative sedation in parturients undergoing CS. Neither dexmedetomidine nor midazolam caused significant hemodynamic changes.

Effects of Adding Intrathecal Epinephrine to Spinal Anesthesia on Anesthesia-Related Cesarean Delivery Outcomes: Should We Reconsider Its Use?

Intrathecal epinephrine is used to increase the duration of spinal anesthesia for amenable surgical procedures anticipated to require additional time; however, in the ambulatory setting, it is associated with a prolonged time to post-anesthesia care unit (PACU) discharge. The current study's authors hypothesized that adding intrathecal epinephrine to spinal anesthesia for cesarean delivery would be associated with a dose-dependent prolonged post-anesthesia unit length of stay. A single-center, retrospective study of patients undergoing repeat cesarean delivery under spinal anesthesia from 2011 to 2015 was conducted. Patients received spinal bupivacaine 12 mg, morphine 150 mcg, and fentanyl 15 mcg with no-epinephrine, 100 mcg, or 200 mcg of epinephrine. The primary outcome was recovery room length of stay. Secondary outcomes were surgical duration, intraoperative vasopressor use, perioperative opioids, and antiemetic use. Data were analyzed for 1,362 patients. Median recovery room stay was 123 min (interquartile range, 100 to 150) and was not different among groups. More women receiving epinephrine 200 mcg had ≥2 prior cesarean deliveries compared with no-epinephrine or 100 mcg. No significant differences in surgical duration or intraoperative opioids were identified among the groups. Median intraoperative vasopressor use was increased by 225 mcg of phenylephrine equivalents (99% CI, 25 mcg to 430 mcg) in the 100 mcg group and 250 mcg of phenylephrine equivalents in the 200 mcg group (99% CI, 75 mcg to 500 mcg) compared to no-epinephrine (P<0.001). Recovery room antiemetic and opioid analgesic administration were not different among groups. Based on the results of this study, the addition of intrathecal epinephrine for women undergoing cesarean delivery increases intraoperative vasopressor use but does not prolong PACU length of stay, reduce intraoperative opioids, or increase antiemetic requirements postoperatively. The current study also demonstrated that surgical duration times were not different among the no-epinephrine, 100 mcg, and 200 mcg epinephrine groups.

Efficacy of spinal anesthesia—ultrasound guided versus landmark-based, in patients undergoing spinal anesthesia: a prospective cross-sectional study

Abstract Objective: This research aims to assess the effectiveness and practical value of ultrasound imaging (US group) in minimizing the discomfort and potential hazards associated with spinal anesthesia compared to traditional landmark-based (LM group) approaches. Materials and Methods: In this prospective, randomized comparative investigation, 80 patients were enrolled to undergo spinal anesthesia using either the landmark-based or ultrasound-guided method, with an equal distribution of 40 patients in each respective group. The study recorded various parameters, including evaluation duration, count of needle insertion attempts, instances of redirection, duration of spinal anesthesia, overall procedure time (comprising assessment and administration of spinal anesthesia), and measurement of intrathecal space depth. Patient comfort was evaluated employing a visual analog scale (VAS). Results: Demographic characteristics, including age, gender, and body mass index, exhibited no notable differences. The overall procedure time was approximately 2–3 min for the LM group and 3–4 min for the US group, with a statistically significant difference (P &lt; 0.0001). The initial successful needle insertion rate was considerably more critical in the US group (52.5%) than in the LM group (10%). The distance from the skin to the subarachnoid space was notably more remarkable in the US group, with a statistically significant distinction from the LM group (P = 0.034). The successful spinal needle placement rate was 77.5% in the US group, significantly surpassing the LM group’s rate of 25% (P &lt; 0.05). Regarding patient comfort assessed using the VAS, the US group demonstrated significantly greater comfort levels than the LM group. In the US group, every patient reported a VAS score of &lt;4, whereas only 27.5% achieved the same level of comfort in the LM group. Conclusion: Our study provides evidence supporting the utility of pre-procedural ultrasound evaluation of the subarachnoid space as an effective tool for achieving successful lumbar punctures in patients receiving spinal anesthesia. Compared to the traditional landmark technique, this approach reduces the number of attempts required while enhancing patient comfort.

Comparison of effectiveness between two different doses of intravenous dexmedetomidine as adjuvant to subarachnoid block for sub umbilical surgeries

Background. Spinal anesthesia was a commonly used technique in anesthetic practice for lower abdominal and lower limb surgeries. To prolong the duration of bupivacaine spinal anesthesia adjuvants like α2 agonists and opioids have been used intrathecally. Clonidine and dexmedetomidine have also been found to prolong the duration of spinal anesthesia when given intravenous. Dexmedetomidine was more suitable adjuvant to spinal anesthesia compared to clonidine as it has more sedative and analgesic effects due to more selective α2A receptor agonist activity. Dexmedetomidine has been shown to prolong the duration of analgesia of spinal anaesthesia in various studies. Here we compare the two doses of Dexmedetomidine in prolonging the duration of analgesia. Material and methods. 60 American Society of Anaesthesiologists(ASA) physical status I/II patients scheduled for elective lower abdominal and lower limb surgeries under spinal anesthesia were randomized into two groups of 30 each. Immediately after subarachnoid block with 3.5ml of 0.5% hyperbaric bupivacaine, Group A patients received a loading dose of 0.5µg/kg of dexmedetomidine intravenously in 100ml NS over 10 mins whereas Group B received 1.0µg/kg of dexmedetomidine intravenously in 100ml NS over 10 mins. Results. Time for rescue analgesic were higher in Group B compared to Group A which was statistically significant but clinically the extra duration was insignificant. Time for two segment regression and duration of motor blockade was significantly prolonged in Group B. Requirement of Mephentermine was comparable in both the groups. There was no excessive sedation in both the groups. Conclusion. Dexmedetomidine administered as isolated loading dose of 0.5 µg/kg IV immediately after spinal anaesthesia was clinically equi-efficacious in prolonging the duration of analgesia of spinal anaesthesia compared to a larger dose of 1.0 µg/kg. The side effect profile, hemodynamic stability, sedation levels, need for vasopressors and atropine were comparable in both groups.

Dexmedetomidine vs. fentanyl as adjuvants to hyperbaric bupivacaine for unilateral spinal anesthesia in lower limb orthopedic surgeries: a randomized trial

Background &amp; Objective: Opioids and α2 adrenergic receptor agonists are commonly used as adjuvants to intrathecal local anesthetics to improve the quality and duration of spinal anesthesia (SA). Fentanyl and dexmedetomidine (DEX) are the most commonly used opioid and α2 agonist respectively. We compared the efficacy of these two when used as adjuvants to hyperbaric bupivacaine for SA for lower limb surgeries.&#x0D; Methods: A total of 54 patients were randomly assigned to receive unilateral spinal anesthesia with bupivacaine 2.5 ml. Group F (n = 27) received 25 μg fentanyl, and Group D received 10 μg DEX added to the spinal bupivacaine. Time to first analgesic request was the primary outcome, while sensory and motor block characteristics, nalbuphine consumption as rescue analgesic, pain scores, side effects and sedation levels were the secondary outcomes.&#x0D; Results: Patients receiving dexmedetomidine as an adjuvant to hyperbaric bupivacaine for spinal anesthesia for lower limb surgeries had a significantly longer time to rescue analgesia than those receiving fentanyl. The mean time to rescue analgesia in Group D was 409.63 ± 74.60 min vs. 295.93 ± 36.72 min (P = 0.000) in the Group F. Also, patients in Group D had significantly longer sensory and motor blocks.&#x0D; Conclusion: Intrathecal dexmedetomidine 10 μg seems to be a good alternative to fentanyl 25 μg when used as an adjuvant in unilateral spinal anesthesia for lower limb orthopedic surgeries with better quality postoperative analgesia and with minimal side effects.&#x0D; Abbreviations: DEX - Dexmedetomidine; NYHA - New York Heart Association; BMI - Body mass index; MBP - Mean blood pressure; SBP- Systolic blood pressure; DBP- Diastolic blood pressure; VAS - Visual Analog Scale&#x0D; Key words: Dexmedetomidine; Fentanyl; Bupivacaine; Anesthesia, Spinal&#x0D; Citation: Ghaly SI, Shafik AM, AlTaher WAMM, Motawashleh MG, Alansary AM. Dexmedetomidine vs. fentanyl as adjuvants to hyperbaric bupivacaine for unilateral spinal anesthesia in lower limb orthopedic surgeries: a randomized trial. Anaesth. pain intensive care 2023;27(4):456−463. DOI: 10.35975/apic.v27i4.2191&#x0D; Received: March 30, 2023; Reviewed: April 22, 2023; Accepted: April 22, 2023

Segmental Thoracic Spinal Anesthesia for Laparoscopic Cholecystectomy with the "Hypobaric" Technique: A Case Series.

Several studies have applied lumbar spinal anesthesia (SA) with isobaric/hyperbaric bupivacaine and opioids in elective laparoscopic cholecystectomy (LC), documenting a superiority of the methodic over general anesthesia (GA) in terms of perioperative pain, nausea, and vomiting, though with a notable incidence of intraoperative right shoulder pain, potentially responsible for conversion to GA. This case series presents an opioid-free scheme of segmental thoracic spinal anesthesia (STSA) with hypobaric ropivacaine, reporting its benefits mainly in terms of shoulder pain occurrence. Hypobaric STSA was performed in nine patients undergoing elective LC between May 1 and September 1, 2022. The level of the needle insertion was included between T8 and T9, via a median or a paramedian approach. Midazolam (0.03 mg/kg) and Ketamine (0.3 mg/kg) were used as adjuvants for intrathecal sedation, followed by the administration of hypobaric ropivacaine 0.25% at a dose of 5 mg and then isobaric ropivacaine at a dose of 10 mg. Patients were placed in anti-Trendelenburg position for the entire duration of surgery. LC was conducted through the standard 3 or 4 ports technique with pneumoperitoneum maintained at a pressure of 8-10 mmHg. Mean patient age was 75.7 (±17.5) years, with a mean ASA score and Charlson comorbidity index (CCI) of 2.7 (±0.7) and 4.9 (±2.7), respectively. STSA was completed without complications in all patients, with no need for conversion to GA. Mean operative time and SA duration were 37.5 (±8.7) and 145.2 (±21.8) min, respectively. Intraoperatively, no shoulder or abdominal pain and nausea were reported, with only four and two patients requiring vasopressor and sedative intravenous drugs, respectively. Postoperatively, overall mean VAS pain score and within the first 12 hafter surgery were 3 (±2) and 4 (±2), respectively. Median length of stay was 2 (range = 1-3) days. Hypobaric opioid-free STSA appears to be a promising approach for laparoscopic surgeries, with minimal to null occurrence of shoulder pain. Larger prospective studies are required to validate these findings.

Evaluation of the Effect of Intravenous Dexamethasone on the Duration of Spinal Anaesthesia in Parturients Undergoing Lower Segment Caesarean Section.

Introduction Dexamethasone is shown to prolong the duration of nerve blocks when administered perineurally as well as intravenously. The effect of intravenous dexamethasone on the duration of hyperbaric bupivacaine spinal anesthesia is lesser known. We conducted a randomized control trial to determine the effect of intravenous dexamethasone on the duration of spinal anesthesia in parturients undergoing lower-segment cesarean section (LSCS). Methods Eighty parturients planned for LSCS under spinal anesthesia were randomly allocated to two groups. Patients in group A were administered dexamethasone intravenously, and group B received normal saline intravenously before spinal anesthesia. The primary objective was to determine the effect of intravenous dexamethasone on the duration of sensory and motor block after spinal anesthesia. The secondary objective was to determine the duration of analgesia and complications in both groups. Result The total duration of the sensory and motor blocks in group A was 118.38 ± 19.88 minutes and 95.63 ± 19.91 minutes, respectively. The entire sensory and motor blockade duration in group B was 116.88 ± 13.48 minutes and 97.63 ± 15.15 minutes, respectively. The difference between the groups was found to be statistically insignificant. Conclusion Intravenous 8 mg dexamethasone in patients planned for LSCS under hyperbaric spinal anesthesia does not prolong the sensory or motor block duration compared to placebo.

EFFECT OF NALBUPHINE AND TRAMADOL IN POST-SPINAL ANAESTHESIA SHIVERING: A COMPARATIVE STUDY

Background: In Spinal anaesthesia, a consequence of impaired thermoregulatory control, shivering is one of the most frequently reported complications of central neuraxial blockade, affecting 40–70% of patients. Nalbuphine is a mixed opioid agonist–antagonist with high afnity for the opioid receptor that functions as both a competitive opioid antagonist and a partial opioid agonist. Theoretically, nalbuphine could have signicant anti-shivering effects on post-anaesthetic shivering. This prospecti Methods: ve randomised (computer-generated) double-blinded study was conducted at Department of Anaesthesiology and Intensive Care, Government Medical College Jammu J&amp;K, after obtaining approval from hospital ethical committee. Randomisation was done using a computer-generated number where patients were randomly allocated into two groups: Group-N and Group-T. We conned our investigation to 84 patients divided into two equal groups of 42 people. The non- Results: signicant difference was observed in age, gender, BMI, ASA physical status, duration of surgery, and duration of spinal anesthesia between the groups. The drug was found to signicantly reduce SBP, increase DBP, and increase MAP in the group given the drug compared to the nalbuphine group. The time taken to control shivering was signicantly shorter in the group-T. The group-T also had a lower Ramsay Sedation Scale score, indicating less sedation compared to the group-N group. The drug did not cause any adverse effects, while sedation, hypotension, and bradycardia were observed in the group-N. Nausea, vomiting, and dizziness were reported in the group-T, but not in the group-N. There was no signicant difference in the effectiveness of shivering control between the two groups. Both i Conclusion: ntravenous nalbuphine 0.05 mg/kg and tramadol 1 mg/kg are effective in managing post-spinal anesthesia shivering. However, tramadol had a shorter time to control shivering than nalbuphine. Both drugs had minimal effects on blood pressure and heart rate, and the side effects observed were minor and treatable

COMPARATIVE STUDY OF CLONIDINE AND FENTANYLAS ADJUVANTS TO INTRATHECAL ROPIVACAINE TO ASSESS THE DURATION OF ANALGESIA IN LOWER LIMB SURGERIES.

Objective: Ropivacaine has the benet of providing appropriate intraoperative anaesthesia and effective postoperative analgesia when used for lower limb procedures under spinal anaesthesia, but some patients still experience pain after the medication has taken its full course of action. Adjuvants added to local anaesthetics have the advantage of extending the sensory-motor block's duration and lowering the overall dose necessary.4 This study compared Clonidine and Fentanyl as adjuvants to intrathecal ropivacaine in enhancing the quality of anaesthesia by postponing the requirement for analgesics. Methods: 100 Patients who were undergoing lower limb surgeries were selected for the study and divided into two groups of 50 each. Patients were randomly allocated to one of the two groups using envelope method for blinding the investigator. GROUP A patients received 2.5ml 0.75% Ropivacaine(18.75mg) + Clonidine(60μg) 0.2ml, GROUP B patients received 2.5ml 0.75% ropivacaine(18.75mg) +Fentanyl (20mcg) 0.2ml. The following parameters were noted: Time of injection of subarachnoid block, Time of onset of sensory block at T10 level, Time of onset of motor block, Duration of motor block, Degree of sedation. Results and discussion: No difference in the onset of sensory and motor blockade between the two groups. There was statistically signicant prolongation in the duration of motor blockade in clonidine group 195.6 minutes when compared with fentanyl group 157.8 minutes (p &lt; 0.001). Analgesic duration was signicantly higher in clonidine group 321.70 ± 48.93 min when compared with fentanyl group 273.60 min (p = &lt; 0.001).The difference in haemodynamic parameters – heart rate, systolic &amp; diastolic blood pressure, mean arterial pressure (except for systolic blood pressure at 150 minutes) were statistically insignicant between both the groups. Sedation was slightly higher in the fentanyl group when compared to clonidine group but was statistically insignicant. None of the patients required supplemental oxygen, analgesia, or anxiolysis intraoperatively. No signicant difference in the incidence of complications like bradycardia, hypotension, respiratory depression etc between the two groups. Conclusion: In our study subarachnoid block with 0.75% isobaric ropivacaine (2.5ml) for lower limb surgeries with addition of clonidine 60mcg as anaesthetic adjuvant has advantage over fentanyl 20 mcg, as it increases the duration of spinal anaesthesia and increases postoperative analgesic duration. No signicant complications were recorded in both study groups