Duration Of Spinal Anesthesia Research Articles

Efficacy of Adding Midazolam to Bupivacaine (0.5%) on the Duration of Spinal Anesthesia in Unilateral Inguinal Hernia Surgery

Introduction: Inguinal hernia is the most common type of abdominal hernia which is 7 times more common in men than women. Surgical treatment is performed under general or local anesthesia (spinal or epidural). Neuraxial anesthesia has a greater advantage than general anesthesia. Today, spinal block anesthetics with local drug anesthetics along with adjuvant drugs is widely used for surgery. Midazolam is one of these adjuvants whose spinal injection, in addition to its appropriate analgesic effect, enhances the effect of local anesthetics. Aim: The aim of this study was to determine the effect of intrathecal midazolam (1 mg) to bupivacaine (0.5%) on the quality and timing of sensory block, motor block and hemodynamic changes during of inguinal herniation surgery. Materials and Methods: 64 patients with ASAI / II criteria (30-70 years old) were randomly divided into two groups of 32 patients under spinal anesthesia for inguinal herniation surgery. The anesthesiologist and the patient did not know the status of the studied drugs. Group 1 received 0.5 ml of bupivacaine 0.5% + 0.2 ml of normal saline and group 2 received 3 ml of bupivacaine 0.5% + 0.2 ml of midazolam (1 mg). The return time of sensory block and the return time of motor block, the time of the first request for analgesics, the degree of satisfaction and the hemodynamic status were compared between these group. Results: The return time of sensory block in group 1 was 124.81 ± 16.15 minutes and in group 2 was 193.18± 34.53 minutes, which was statistically significant and in group 2 the return time of sensory block was longer (001 ≤. ˂P). reaction block return time: in group 2: (140.43 ± 27.46) minutes, group: 1 (107.78 ± 13.82) minutes were shorter and statistically significant (P≤ .001). The time of the first analgesic request by patients in group 1 was 157.87 ±16.32 minutes and in group 2, 264.59 ± 50.17 minutes, which was statistically significant (P ≤ .001). Satisfaction index and hemodynamic changes were not significant between groups (P ˃ 0.05). Conclusion: Addition of 1 mg of midazolam in spinal anesthesia with bupivacaine 0.5% increased of the duration of analgesia and the time of first request for analgesia without changing the hemodynamic status in patients with inguinal herniation surgery.

Efficacy of intravenous dexamethasone for post-operative pain relief in elective cesarean section

Background: Various additives have been evaluated for the purpose of enhancing quality of analgesia and prolonging duration of spinal anesthesia. Aims and Objectives: This randomized study was conducted to evaluate the efficacy of intravenous dexamethasone in spinal anesthesia. Materials and Methods: A total of 100 patients scheduled for lower segment cesarean section under spinal anesthesia were randomly allocated into two groups, Group-1 and Group-2, including 50 patients each. All the patients received injection bupivacaine 0.5% heavy 10 mg for spinal anesthesia. Group-1 received injection dexamethasone 8 mg intravenously, and Group-2 received injection normal saline 2 cc immediately after spinal anesthesia. Duration of sensory and motor block, post-operative analgesia, visual analog pain scale (VAS) score, time of rescue analgesia, total analgesic requirement in the first 24 h, intra- and post-operative hemodynamics, and side effects if any were recorded. Results: The mean duration of sensory block (min) in Group-1 and Group-2 was 162.50 and 106.17, respectively. Time to the requirement of first rescue analgesia was 8.67 h in Group-1 and 4.40 h in Group-2. Significant changes seen in VAS score in post-operative period after 1 h of surgery in Group-1 and Group-2. Group-1 had more duration of sensory block, prolonged requirement of first rescue analgesia. Duration of motor block and intra- and post-operative hemodynamic parameters was comparable in both the groups. No side effects were recorded in both the groups. Conclusion: We conclude that administration of dexamethasone 8 mg intravenously prolongs the duration of post-operative analgesia and sensory block in patients undergoing lower segment cesarean section under spinal anesthesia.

Pendant Positioning Vs Traditional Sitting for Successful Spinal Punctures in Elderly

Background- The ability of the pendant position in increasing the intervertebral spaces translating in an increase in the 1st attempt spinal puncture success rate has been reported in pregnant females undergoing cesarean section. However, the same has not been done for the elderly patients in which age-related degenerative anatomical changes, decreased lordosis, disseminated sclerosis, and extensive osteophytosis is known to reduce the intervertebral space. Materials and Methods- A prospective randomized controlled study was conducted in patients aged 60-80 years undergoing urological surgeries after approvalfrom the Institutional Ethics Committee and written informed consent from the patients. Primary aim was to compare the number of bone contacts during administration of subarachnoid block with the patient in either pendant (Group A) or traditional (Group B) position. Secondary aims were to compare the proportion of successful spinal needle placements, ease of palpation of spinous processes, patient’s comfort, number of spaces used, time to perform spinal puncture, time to reach grade III (as per modified bromage score) motor blockade, time to reach T10 sensory level and rate of complications in both the groups. Results- Demographic data was comparable and there was no statistical difference in number of bone contacts, ease of administration, success of spinal needle placements, performance times of subarachnoid block and duration of spinal anaesthesia in both the groups. Complication rates were comparable. Conclusion- Pendant positioning does not confer any advantage over the traditional sitting position in success rates and performance characteristics of subarachnoid block in elderly (60-80 years) patients scheduled for urological surgeries. Keywords: Pendant position, Spinal-bone contact, Spinal Needle Puncture, Lumbar puncture, Spinal anesthesia, Aged

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

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

Effect of Low Dose Intravenous Magnesium Sulphate on Sensory Regression Time in Patients undergoing Spinal Anaesthesia- A Randomised Placebo-controlled Double-blinded Study

Introduction: Adjuvants like intravenous (i.v.) Magnesium Sulphate (MgSO4 ) are used to improve the efficacy and duration of spinal anaesthesia and postoperative analgesia. But it is unclear, whether this prolongation of duration of analgesia is an independent effect of MgSO4 or it is because of increased duration of spinal anaesthesia itself. Aim: To evaluate the effect of intraoperative i.v. low dose MgSO4 on two-segment regression time of sensory block, regression time up to L2 dermatome from the highest level of sensory block and postoperative analgesic requirement. Materials and Methods: This randomised placebo-controlled blinded study was conducted in the Department of Anaesthesia, Fakhruddin Ali Ahmed Medical College and Hospital, Barpeta, Assam, India from September 2020 to August 2021. A total of 60 patients, satisfying American Society of Anaesthesiology (ASA) physical status I and status II, aged between 40-70 years, patients undergoing femur fracture surgery under spinal anaesthesia were enrolled in the present study. Patients in the magnesium group (Group M, n=30) received MgSO4 5 mg/kg infusion, and control group (Group C, n=30) received at the same volume of saline during operation. Unpaired t-test was used to test the significance in normally distributed continuous variable and Mann-Whitney U test was used to test the significance of the difference between the quantitative variables. The software Predictive Analytics Software (PASW) 18.0 was used for statistical analysis and the graphs have been generated using the Microsoft Excel 2007. A p-value of less than 0.05 has been considered to be significant. Results: There were no significant differences between the two groups with respect to patient characteristics (age, weight, and height).The mean time for two segment regression in the group M was prolonged by around 13 minutes, as compared to group C (104.96±11.37 minutes versus 91.2±11.86 minutes, respectively, p<0.001). The mean regression time up to L2 dermatome in the group M was prolonged by 15 minutes as compared to the group C. (171.23 minutes versus 156.43 minutes, respectively, p=0.0003). The total consumption of tramadol in the group M was significantly lesser than the control group (192.5±58.03 mg and 245.0±43.74 mg, respectively, p=0.0002). Conclusion: An i.v. infusion of 5 mg/kg MgSO4 prolongs two segment regression time upto L2 dermatome and reduces postoperative opioid consumption without any complication in patients undergoing femur fracture surgery under spinal anaesthesia

“Preoperative oral duloxetine: does it affect duration of spinal anesthesia and early postoperative pain after arthroscopic ACL repair?” A prospective, randomized, double-blind controlled trial

BackgroundPostoperative pain is one of the problems in which a lack of adequate controls can cause many complications. Duloxetine is a potent serotonin and norepinephrine reuptake inhibitor (SNRI) prescribed for the treatment of depression, chronic pain, neuropathy, and recently early postoperative pain.ResultsThe results showed that the effect of duloxetine on the onset and duration of the spinal anesthesia was statistically non-significant (P = 0.067 and P = 0.21) respectively; also, duloxetine delayed the time to the first dose of rescue analgesia request (479.71 ± 50.32 vs 218.29 ± 12.48) (P < 0.001) and maintained VAS score in the lower range in comparison to control group (P = 0.001) with less frequency and total morphine consumption (4.2 ± 2.08 vs 10.37 ± 1.52) (P < 0.001) up to 24 h. No significant differences in adverse effects.ConclusionsA single dose of 60 mg duloxetine orally 2 h before arthroscopic ACL repair provided better postoperative pain control and decreased total morphine consumption without affecting the duration of spinal anesthesia.

A comparative study of intrathecal dexmedetomedine and magnesium sulfate as adjuvants to bupivacaine in total hip replacement

Background & Objectives: Spinal anaesthesia is a popular technique for providing anaesthesia for total hip replacement (THR). Intrathecal adjuvant is given along with local anaesthesia to prolong duration of block. Intrathecal administration of dexmedetomidine and magnesium sulphate is known to enhance duration of block without causing significant side effect. The purpose of this study was to assess the impact of intrathecal dexmedetomidine and magnesium sulfate on the onset and duration of spinal anaesthesia using bupivacaine. Methods: After IEC approval, a prospective, randomized, double blinded study was conducted on 120 ASA I and II adult patients undergoing THR under spinal anaesthesia. Patients were randomly divided into three groups: Group D received 0.1 ml (10 μg) Dexmedetomidine, Group M received 0.1 ml (50 mg) Magnesium sulfate and Group C received 0.1 ml normal saline as control. All the patients in this study received 15 mg of hyperbaric bupivacaine. Time for sensory onset, Time for motor onset, Duration of Sensory Block, Duration of Motor Block, Duration of Analgesia and Incidence of Side Effects were recorded.Results: The haemodynamic parameters like systolic blood pressure, diastolic blood pressure and mean heart rate for the groups were comparable. The onset of sensory and motor block were significantly the fastest for Group D (p< 0.0001). The duration of sensory and motor block were significantly longer for Group D as compared to both the groups (p< 0.0001). The duration of analgesia was significantly prolonged for Group D as compared to both groups (p< 0.0001).Conclusion: Dexmedetomidine added to spinal Bupivacaine shortens the time of recovery and motor onset. It prolongs the duration of both sensory and motor blockade. It also provides significant post-operative analgesia.

Abstract No. : ABS3660: Comparative study of perioperative effect of premedication with melatonin versus pregabalin total hip arthroplasty under spinal anaesthesia.

Background & Aims:The aim of the present study was to compare the efficacy of melatonin and pregabalin in reducing perioperative anxiety and postoperative pain along with effects on onset and duration of spinal anaesthesia and level of sedation in patient undergoing total hip arthroplasty under Spinal anaesthesiaMethods:The present study was a randomised double blind placebo controlled studyand included96 American society of Anesthesiologists (ASA) I and II patients of either sex, aged between 30 to 60 years scheduled for total hip replacement under spinal anaesthesia. The patients were randomly allocated to one of three groups of 32 each to receive placebo (group 1), melatonin 6 mg (group 2), pregabalin 150 mg (group 3) orally 2 hours before spinal anesthesia. Perioperative anxiety using Beck anxiety inventory, postoperative pain along with onset and duration of spinal anaesthesia and sedation were assessed at multiple time points in the first 24 hours after surgery.Results:Perioperative anxiety scores was significantly decreased in group 2 (11.08) and group 3 (7.26) when compared to group1(17.25) and significant decrease in group 3 when compared to group 2. Post operative Visual analogue scale VAS scores were decreased in group 2 and 3 when compared to gropup1. Request for rescue analgesic during the first post operative 24 hour were lower among groups 2 and 3. The duration of sensory and motor blockade was prolonged in groups 2 and 3.Conclusion:Premedication with single dose of melatonin 6mg and pregabalin 150mg 2 hours before surgery decreases perioperative anxiety and postoperative pain in patients undergoing total hip arthroplasty under spinal anaesthesia and pregabalin has an added advantage of anxiolysis when compared to melatonin.Group 1 (Mean+SD)Group 2 (Mean+SD)Group 3 (Mean+SD) P Anxiety 2 h before16.25+1.1615.94+1.5416.16+1.50.705Anxiety in OT17.05+1.2610.00+0.806.03+0.9670.000*Anxiety before Spinal17.25+1.0511.08+0.67.26+0.70.000*Anxiety after Surgery10.13+1.126.41+0.563.13+0.6600.000*Onset of Sensory Effect (min)4.24+0.054.11+0.034.09+0.0250.000*Duration of Spinal Anaesthesia (min)211.13+12.25247.22+6.07267.94+6.70.000*Onset of Motor Effect (min)8.39+0.0988.19+0.0757.9+0.2850.000*Duration of Motor Blockade (min)165.25+5.8179.78+5.7194.84+7.030.000*

Effect of adding midazolam to intrathecal bupivacaine in children undergoing lower abdominal surgeries: A randomised controlled trial.

Background and Aims:Avoidance of general anaesthesia for short-duration surgeries is a prerequisite, especially for children. Spinal anaesthesia is established as an appropriate anaesthetic procedure for this target. Midazolam has been proven to be safe for children as premedication. This study aimed to evaluate the effects of adding midazolam to intrathecal bupivacaine on intraoperative quality, duration of spinal anaesthesia and postoperative (PO) analgesia for children undergoing lower abdominal surgeries.Methods:A prospective, comparative interventional study included 120 paediatric patients who were randomly divided into two groups that received intrathecal bupivacaine plus normal saline (B/S) or intrathecal bupivacaine plus midazolam (B/M). The efficacy of PO analgesia was assessed using the observational pain–discomfort scale (OPS). Duration of PO analgesia was measured, and recovery of motor block was assessed every 30 min till the Bromage scale reached 0. The level of PO sedation was assessed using the modified Wilson Sedation Score (WSS). Results were analysed using the one-way analysis of variance (ANOVA) test, Mann–Whitney test and Chi-square test.Results:Onset of sensory and motor blocks was significantly faster, and the frequency of patients having Bromage score of 3 within ≤10 min was significantly higher in group B/M than group B/S. Durations till sensory and motor recovery were significantly longer, the number of requests for PO analgesia was significantly lower and the mean of WSS was significantly higher at 30 and 120 min in group B/M than group B/S.Conclusion:Intrathecal bupivacaine–midazolam combination significantly prolonged the duration of spinal anaesthesia and provided prolonged PO analgesia.

Effect of Intra-articular Dexmedetomidine on Postoperative Pain after Knee Arthroscopic Surgery.

This study aimed to prevent and control the pain after arthroscopy that leads to patient satisfaction, rehabilitation, and return to normal life as soon as possible. It is hypothesized that there is no difference between intra-articular injection of dexmedetomidine and placebo after knee arthroscopy regarding pain level. This double-blind randomized clinical trial was conducted on 70 patients aged 18-60 years who were candidates for elective knee arthroscopic surgery with the American Society of Anesthesiologists Classification I-II. All patients underwent spinal anesthesia equally and were randomly divided into two groups of 35 cases per group. The drug group (D) received 2 μg/kg dexmedetomidine with 0.9% normal saline reached to a volume of 20 ml, and 20 ml of 0.9% normal saline was injected into the knee joint through the cannular sheath in the control group (C). Postoperative pain intensity was recorded 1, 2, 4, 8, 16, 24 h after injection using the Visual Analogue Scale. The time of requesting the first analgesic and the amount of analgesics consumed were recorded after 24 h. There was no significant difference between the two groups in terms of age, height, weight, duration of spinal anesthesia, and duration of surgery (P>0.05). In group D, there was a decrease in postoperative pain, a decrease in the amount of analgesic consumed, and an increase in the time of the first analgesic request, compared to group C (P<0.05). This study showed that intra-articular injection of dexmedetomidine relieved postoperative pain, reduced analgesic consumption, and increased the time of first analgesic request after knee arthroscopy.

Comparative Study of the Effect of Clonidine and Butorphanol as Adjuvant to Intrathecal Bupivacaine for Post Operative Analgesia in Lower Abdominal and Lower Limb Surgeries

Background: Intrathecal adjuvants to local anesthetic enhance the quality and duration of spinal anaesthesia. The present study was aimed to comparatively evaluate clonidine and butorphanol as adjuvants to intrathecal hyperbaric bupivacaine for subarachnoid blockade during lower abdominal and lower limb surgeries. Patients and Method: Sixty adult consented patients, undergoing elective lower-abdominal and lower-limb surgeries under subarachnoid blockade, were inducted in a blind randomized prospective study conducted in the Department of Anesthesia, GMC Jammu and allocated into 2 equal groups to receive either 3.2 ml of 0.5% hyperbaric bupivacaine (16mg) with 0.2 ml of Clonidine 30 µgm (Group I) or with 0.2 ml of Butorphanol 200 µgm (Group II). Patients were compared for the onset and duration of sensory and motor blockade, intraoperative hemodynamic changes, time to first rescue analgesia, etc. Result: The mean onset time of sensory block was 3.18±0.56 min in Group I and 3.69±0.83 min in Group II. Complete motor block was achieved in 11.53±3.05 min in Group I and in 12.72±3.17 min in Group II, with no significant difference. (p = 0.138) The duration of motor block was 294.28±33.85 min in Group I, as compared to patients of butorphanol group 245.71±30.92 min,(p = 0.046). The need for rescue analgesia was significantly earlier in Group II, ie at 211.09±20.74 min, while at 256.32±24.40 min in group I. Conclusion: Clonidine and butorphanol are good adjuvants to hyperbaric bupivacaine for spinal anaesthesia. Clonidine provides longer duration of sensory and motor blockade and prolonged duration of postoperative analgesia compared to butorphanol. Keywords: Spinal Anesthesia, Clonidine, Butorphanol, Intrathecal Adjuvants, Subarachnoid Blockage.

Comparing Clonidine and Fentanyl as Adjuvants to Intrathecal Hyperbaric Ropivacaine in Elective Infraumbilical Surgeries- A Randomised Clinical Study

Introduction: Ropivacaine is popular as a safe intrathecal anaesthetic drug due to its higher safety profile over bupivacaine. Intrathecal additives are known to increase the quality of anaesthesia and analgesic duration. Aim: To compare the effects of clonidine and fentanyl as intrathecal adjuvants to hyperbaric ropivacaine in elective infraumbilical surgeries. Materials and Methods: This randomized, double-blinded, clinical study was undertaken at Krishnarajendra hospital and Cheluvamba hospital, attached to Mysore Medical College and Research Institute, Mysuru, Karnataka, India, from January 2018 to June 2018. Total 60 adult patients aged between 18-60 years of age, American Society of Anesthesiologists (ASA) I and II status, and posted for infraumbilical surgeries, were randomized to two groups of 30 patients each i.e., group C patients receiving 2.5 mL of hyperbaric 0.42% ropivacaine and clonidine 15 mcg, and group F patients receiving 2.5 mL of hyperbaric 0.42% ropivacaine and fentanyl 25 mcg. The onset, extent and duration of sensory and motor blockade, heart rate, mean arterial pressure, prolongation of analgesia in the post operative period, and any complications were observed. Statistical analysis was done using student’s t-test, and Chi-square test to test significance of variables. The p-value &lt;0.05 was taken as statistically significant. Results: Demographic characteristics were comparable in both the groups. The onset of sensory blockade and the maximum height of sensory blockade attained were similar in both groups i.e., group C-2.12±0.22 min vs group F-2.24±0.66 min, group C-4.94±0.91 min vs group F-5.12±1.38 min, respectively. The duration of sensory blockade was prolonged in group C (148.5±10.84 min vs 109.37±14.5 min), resulting in delayed demand for analgesic after surgery in this group. The onset of motor block and the complete motor blockade was prolonged in group C patients (3.22±1.01 min vs 1.16±0.3 min, 6.8±1.49 min vs 3.72±1.31min). The recovery from motor blockade was also significantly delayed in Group C (125.17±13.29 min vs 95.47±13.08 min). The incidence of hypotension was similar in both the groups. Conclusion: Clonidine, and fentanyl both provide early and adequate spinal anaesthesia, but the former (clonidine 15 mcg), prolongs the duration of spinal anaesthesia with Ropivacaine 0.42% hyperbaric solution, and significantly increases the time for the demand for analgesia in the recovery period, compared to fentanyl

Relationship between Spinal Anesthesia and Hypothermia Incidence among Post Operative Patients in the Operating Recovery Room "JIH" Hospital Yogyakarta

Introduction: Complications of surgery may lead the patient to experience ill and even death. One of the complications in the patient after surgery with spinal anesthesia is the incidence of hypothermia. Hypothermia can occur as a result of a combination of anesthesia and surgery that causes disturbance in body temperature regulation that can make decreasing body temperature. Method: This research uses a descriptive correlational method with a retrospective approach, with total sampling technique amount of 106 respondents, using a checklist sheet research instrument.Data analysis techniques spearman rank. Results: The characteristics of surgery patients with spinal anesthesia in the operating room of Yogyakarta "JIH" Hospital were mostly female, 87.9%, most of whom were adults 74.1%, the highest frequency of surgery with spinal anesthesia duration &gt;2 hours 55.7% and had an incidence of hypothermia 54.7%. Correlational statistical analysis obtained a Cramer's value of 0.371, a correlation coefficient value of 0.348 with a probability value (p-value) of 0.000. Conclusion: There is a relationship between spinal anesthesia and hypothermia incidence among postoperative patients in the operating recovery room "JIH" Hospital Yogyakarta. The direction of the correlation is positive and closeness is sufficient.

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

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

A prospective double blind randomized controlled comparison of different dexmedetomidine doses and their effect on the duration of spinal anesthesia

A prospective double blind randomized controlled comparison of different dexmedetomidine doses and their effect on the duration of spinal anesthesia

Comparative Evaluation of Two Different Doses of Pre-Emptive Oral Pregabalin on Duration of Spinal Anesthesia and Postoperative Pain

Background: Pregabalin provides good postoperative analgesia in nociceptive stimuli. Various studies show that preemptive oral pregabalin reduces acute postoperative pain. We conducted a study to evaluate the efficacy of two different doses of pregabalin and its effect on onset and duration of spinal anesthesia and postoperative pain. Methods: In prospective, double-blind and randomized study, 60 patients posted for vaginal hysterectomy under spinal anesthesia were randomly allocated to two groups recieving cap. Pregabalin 75 mg (group 1) and cap pregabalin 150 mg (group 2) orally, 90 min prior to surgery. Onset and duration of motor and sensory blockade were observed. Postoperative pain was assessed by VAS for 24 hrs. Injection paracetamol 1 gm. was given intravenously as rescue analgesic. Time of first rescue analgesic and total dose of rescue analgesics was noted. Results: Group 2 patients had better postoperative analgesia in terms of prolonged sensory and motor blockade which correlated well with the time of first request for rescue analgesia (504±123.2 min) as compared to group 1 patients (304.9±37.6 min). Also the total dose of rescue analgesic (paracetamol) was significantly less with 150mg pregabalin (p = 0.0001). Conclusion: Pregabalin 150 mg prolongs the duration of spinal anesthesia and has better analgesic profile without significant side effects. Thus we conclude that 150 mg pregabalin given preemptively optimizes spinal anesthesia well in patients for vaginal hysterectomy.

CLINICAL COMPARATIVE STUDY BETWEEN INTRATHECAL DEXMEDETOMIDINE AND DEXAMETHASONE ON PROLONGING THE DURATION OF INTRATHECAL BLOCKADE IN LOWER LIMB ORTHOPEDIC SURGERY

Background: Spinal anesthesia is safer than general anesthesia during lower limb operations; many studies have been concerned about prolonging the duration of spinal anesthesia by adding different adjuvants. Objective: To compare the efficacy of intrathecal dexmedetomidine versus intrathecal dexamethasone in prolonging duration of spinal anesthesia, and postoperative analgesia, safety and hemodynamic stability. Patients and methods: Our study was carried out on 60 patients of American Society of Anesthesiologists (ASA) physical status I or II, scheduled for orthopedic operation under spinal anesthesiadivided into A, B and C from March 2020 to November 2020. They were divided into 3 equal groups: Group A received 2ml bupivacaine (0.5%) and 10μg dexmedetomidine in 1ml normal saline intrathecal, Group B received 2ml bupivacaine (0.5%) and 4 mg dexamethasone in 1 ml normal saline intrathecal and Group Creceived 2ml bupivacaine (o.5%) and 1ml normal saline Intrathecal. The study was carried out at Al-Azhar University Hospitals (Al- Hussein and Sayed Galal Hospitals). Results: The present study showed statistically significant difference (P-value <0.001) between the three groups according to time of motor and sensory regression. The regression time of block (both sensory and motor) were prolonged in A (sensory 359.50±20.32, motor 319.00±21.06) and B (sensory 199.75±18.22, motor 170.00±20.00) when compared to the C group (sensory 149.55±10.83, motor 141.00±22.09). However, the duration was longest in A group among the three groups. According to amount of analgesic consumption postoperatively, there was significant decrease in amount in A group in comparison to B and C groups. The amount is insignificantly decreased in B group in comparison to C group. Regarding safety and hemodynamic stability there was no statistically significant difference between the three groups. Conclusion: Dexmedetomidine had prolonging the duration of spinal anesthesia more than dexamethasone and control group with statistically significant difference between the three groups and provided prolonged postoperative analgesia compared to dexamethasone and control group.

Comparative study of postoperative analgesia intrathecal addition of fentanyl versus clonidine in lower limb surgeries

Background: Local anesthetic drugs like bupivacaine are commonly used in spinal anesthesia for lower limb surgeries but the duration of spinal anaesthesia is very short. However, the duration of action of bupivacaine in spinal anaesthesia can be prolonged by using adjuvants such as midazolam, opioids, neostigmine, dexmedetomidine and clonidine. The present study is being undertaken to evaluate and compare the effects of clonidine and fentanyl as intrathecal adjuvants to hyperbaric bupivacaine in patients undergoing lower limb orthopaedic surgery. Material and Methods: Present study was conducted in the Department of Anaesthesiology and Intensive Care, Government Medical College, Jammu in patients of either sex ranging in age from 20-60 years belonging to ASA I/ II scheduled for lower limb orthopaedic surgeries. 90 patients were randomly allocated in three groups of 30 each in order to compare the duration and quality of analgesia of clonidine and fentanyl used as adjuvants to intrathecal bupivacaine. Results: All the three groups were comparable in age, gender, height, weight, ASA grade distribution and the difference between them was not statistically significant. The difference between the time to reach the T10 block, mean time taken for first request for analgesia and duration of motor block in all three groups were found out to be statistically significant (p&lt;0.0001). It was found that group with clonidine had better results than fentanyl and bupivacaine alone. In our study 1 patient in bupivacaine (15mg) with fentanyl (25µg) group and 2 patients in clonidine(37.5ugm) group had hypotension but the difference was statistically insignificant. Only 1 patient in each fentanyl and clonidine group had 1 episode of bradycardia but no patient in bupivacaine alone group had bradycardia and the difference was also insignificant. Postoperative vomiting was experienced by 3.33% of patients receiving Bupivacaine (15mg) with fentanyl (25µg) and it was treated by giving injection Ondansetron 4 mg i/v whereas no case was reported in clonidine group. This difference was statistically insignificant. 2 patients in bupivacaine (15mg) with fentanyl (25µg) group had itching but no such case was reported in clonidine group and the difference was also statistically insignificant. No respiratory depression, nausea was noted in study patients. Conclusion: It can be concluded that intrathecal clonidine (37.5ugm) provides quicker onset and prolonged duration of sensory and motor blocks simultaneously increasing the duration of analgesia when compared to fentanyl (25ugm).

Anelgesic Efficacy of Intra-Thecal Tramadol as a Spinal Adjunct to 0.5% Heavy Bupivacaine in Lower Abdominal Surgery

Introduction: Hyperbaric Bupivacaine is the most widely used local anesthetic. A number of adjuvants have been used with local anesthetic agents in order to improve the quality and duration of analgesia and anesthesia. This study was carried out to assess the efficacy of intrathecal Tramadol as a spinal adjunct to prolong the duration of spinal anesthesia in lower abdominal surgeries.&#x0D; Materials and Methods: Sixty patients aged between 18 to 80 years, were randomly divided into two groups - Tramadol and Placebo group. Spinal anesthesia was given by using 25 Gauge Quinke spinal needle in sitting position with midline approach. Patients belonging to Tramadol group received 3 ml of 0.5% Bupivacaine along with 0.5 ml of Tramadol (25mg) and patients belonging to Placebo group received 3 ml of 0.5% Bupivacaine along with 0.5 ml of Normal Saline. In the postoperative ward, duration of analgesia was assessed by the time when first rescue analgesia was given. Visual Analogue Scale for pain was noted at the time of rescue analgesia. The total amount of opioid consumed over 24 hour postoperative period was noted. Hemodynamic like heart rate, systolic, diastolic and mean arterial blood pressures were also noted. Data were analyzed using independent t-test for continuous variables and chi-square test for categorical variables, p value &lt;0.05 was considered significant.&#x0D; Results: The two groups were comparable with respect to age, weight, sex, ASA grading and duration of surgery. Mean duration of effective analgesia was 231.53 ± 22.00 min in Tramadol group and 125.40 ± 8.86 min in Placebo group (p = 0.001). The mean total amount of opioid consumption in 24 hours postoperative period was 145.00 ± 30.31 mg in Tramadol group and 171.67 ± 36.39 mg in Placebo group (p = 0.003). Mean of Heart rate, systolic, diastolic and mean arterial blood pressures were not significant between the two groups. Incidence of nausea and vomiting was statistically significant between the two groups with a p value of 0.010. Hypotension and bradycardia was statistically not significant between the two groups.&#x0D; Conclusion: Tramadol was effective adjuvant to hyperbaric bupivacaine for intrathecal use to increase the duration of spinal anesthesia in patients undergoing lower abdominal surgeries.

The Effect of Different Doses of Intravenous Dexmedetomidine on the Properties of Subarachnoid Blockade: A Systematic Review and Meta-Analysis.

BackgroundDexmedetomidine is a sedative and analgesic medication which has gained an increased usage as an adjuvant to both general and regional anaesthesia in recent years. In this systematic review and meta-analysis, we examined the changes to the characteristics of subarachnoid block when accompanied with intravenous dexmedetomidine. Our aim is to evaluate the effects of different doses of intravenous dexmedetomidine on the sensory and motor blockade duration of a single shot spinal anaesthetic and the incidence of any associated side effects.MethodsWe searched published randomized clinical trials (RCTs) from January 1992 to April 2019 that investigated the use of IV dexmedetomidine with spinal anaesthesia. After considering our inclusion and exclusion criteria, we included 15 RCTs with 985 patients. We analyzed the duration of sensory and motor blockade and the related adverse effects in relation to different doses of IV dexmedetomidine.ResultsIntravenous dexmedetomidine, with loading dose of 1 mcg/kg, prolonged the sensory blockade duration of spinal anaesthesia by a mean difference of 49.6 min, P<0.001, and motor blockade duration by a mean difference of 44.7 min, P<0.001, while a loading dose of 0.5 mcg/kg prolonged the sensory blockade by a mean difference of 43.06 min, P<0.001, and motor blockade duration by a mean difference of 29.09 min, P<0.001. Dexmedetomidine-related side effects were higher in patients receiving larger doses; the incidence of bradycardia was higher (OR=3.53, P<0.001) and incidence of hypotension showed a 1.29 fold increase when compared to the control group (P=0.065).ConclusionThe administration of intravenous dexmedetomidine in conjunction with spinal anaesthesia can significantly prolong the duration of both sensory and motor blockade. The use of larger loading doses of dexmedetomidine was associated with a larger side-effect profile with minimal beneficial changes when compared to lower loading doses.