Elective Infraumbilical Surgeries Research Articles

A comparative study of levobupivacaine 0.25% with dexmedetomidine and dexamethasone as adjuvant in caudal block for pediatric patients undergoing infraumbilical surgeries

Background: The caudal epidural block is one of the most commonly used regional techniques for post-operative pain management in pediatric age group patients undergoing infraumbilical surgeries. Adjuvants use increase the duration of analgesia and decrease local anesthetic dose requirement, thereby decreasing the risk of toxicity. Aims and Objectives: The aim of the present study was to compare the prolongation of the duration of analgesia, hemodynamic parameters, and side effects if any, provided by the addition of dexmedetomidine (DEX) or dexamethasone as an adjuvant to levobupivacaine in the caudal block. Materials and Methods: A total of 60 patients with the American Society of Anesthesiologists grade I/II scheduled for elective infraumbilical surgeries were randomly allocated into two groups of 30 each. Group 1 received levobupivacaine 0.25% 1 mL/kg+DEX 1 mcg/kg and Group 2 received levobupivacaine 0.25% 1 mL/kg+dexamethasone 0.1 mg/kg for caudal block. The duration of analgesia, hemodynamic parameters, and adverse events during the post-operative period were noted. Results: There was no statistically significant difference in hemodynamic parameters between Group 1 and Group 2. Post-operative face, leg, activity, cry, consolability, (FLACC) pain scores were significantly lower in Group 1 when compared with Group 2. The mean duration of analgesia was prolonged in Group 1 at 824.23±53.53 min than in Group 2 with a mean duration of analgesia 480.50±31.66 min which was statistically significant (P<0.005). Adverse events were comparable between the two groups and were statistically not significant (P>0.05). Conclusion: The addition of DEX to levobupivacaine in caudal block significantly prolongs the duration of analgesia in post-operative period in comparison to the addition of dexamethasone with levobupivacaine. It also provides more hemodynamic stability during the intraoperative and post-operative period, lower FLACC pain scores, and is associated with minimal side effects.

A comparative study on the effect of intrathecal nalbuphine and buprenorphine as an adjuvant to 0.5% hyperbaric bupivacaine in elective infraumbilical surgeries

: Subarachnoid blockade provides excellent operating conditions for lower abdominal, orthopedic, pelvic, urological, gynecological and lower extremity surgery. Most subarachnoid anesthetics are single shot injections and have a definite duration; hence opioids have been used along with local anesthetics in subarachnoid block to prolong its effect, duration, quality of analgesia and minimize the necessity of postoperative analgesics.: The primary objective of the study was to assess the onset and duration of sensory and motor blockade. The secondary objective of the study was to compare the hemodynamics, duration of postoperative analgesia and the complications encountered between the two groups.: A prospective randomized double-blinded study was done in 120 patients divided into two group with 60 in each group as group N and group B by computer generated random numbers. Group N received 0.5% Heavy Bupivacaine (3.2ml) + 0.6mg of Nalbuphine (0.3ml) to a total volume of 3.5 ml and Group B received 0.5% Heavy Bupivacaine (3.2ml) + 90µg of Buprenorphine (0.3 ml) to a total volume of 3.5 ml for spinal anesthesia. The differences between the groups were statistically analyzed with the Independent t test for continuous variables and Pearson’s chi-square test for categorical variables. Observations and results: The onset of sensory block (p=0.303) and motor block (p=0.510) was observed to be faster in group N when compared to group B with statistical insignificance, but the duration of both sensory block (p˂0.001) and motor block (p˂0.001) was more pronounced in group B when compared to group N with statistical significance. The duration of effective analgesia was more pronounced in group B (468.35±30.57 minutes) compared to group N (362.70±35.53 minutes).: The duration of the sensory and motor block with effective postoperative analgesia were more pronounced in buprenorphine compared to nalbuphine and hence intrathecal buprenorphine is a better alternative adjuvant to intrathecal nalbuphine in elective infraumbilical surgeries.

A COMPARATIVE STUDY OF EFFECT OF DEXMEDETOMIDINE AND DEXAMETHASONE AS AN ADJUVANT TO 0.2% ROPIVACAINE FOR ULTRASOUND GUIDED TRANSVERSUS ABDOMINIS PLANE BLOCK FOR INFRAUMBILICAL SURGERIES

Background: The relief of pain and suffering is, and always has been, one of the primary concerns of mankind and one of the prime factors that has influenced the course of history of medicine. Transversus abdominis plane (TAP) block is a regional anaesthetic technique which blocks the abdominal neural afferents by introducing local anaesthetic into the neuro-fascial plane between the internal oblique and the transversus abdominis muscle. Aim: To compare the efficacy of Dexmedetomidine and dexamethasone as an adjuvant to 0.2%ropivacaine in ultrasound guided transverses abdominis plane block in infra umbilical surgeries in terms of, 1. Time to initial postoperative pain. 2. Time to initial rescue analgesia. 3. Quality of block.. 4. Total postop analgesic consumption. 5. Patient satisfaction with regard to pain relief. 6. Post-operative nausea and vomiting. Materials And Methods: We included 80 patients of age between 18-60 years of American Society of Anesthesiologists status (ASA)I and II scheduled for elective infraumbilical surgeries in our study. We randomly allotted these patients into two groups namely Group A and Group B of each. Patients in Group APatients who received transversus abdominis plane block with - 18ml Ropivacaine 0.2%+ 2 ml Dexamethasone 8mg. Patients in Group B received transversus abdominis plane block with-18ml Ropivacaine 0.2%+ 2 ml Dexmedetomidine .This TAP block was given soon after the surgery is completed. The duration of block and regression of sensory block, time for rescue analgesia, degree of sedation, hemodynamic parameters, post operative analgesia and adverse effects were noted. Result: The two groups were comparable on the basis of duration of surgery, site of surgery, ASA and BMI. Heart rates and mean arterial pressure were compared and it was found to be significantly lower in group B compared to group A until initial 5 hours. In our study we found that the visual analogue score at rest and on coughing between groups A and B was statistically insignificant. However, the time to first rescue analgesia (330 mins vs 240 mins) and total analgsic consumption in the 24 hours period post operatively was significantly lesser for group A compared to group B. Ramsey sedation score was significantly higher in group B compared to group A until 8 hourspost operatively. Nausea and vomiting in 3 cases of group A , and 2 cases in group B. No other significant side effects were noted. Conclusion: USG-guided TAP block is an effective and safe adjunct for postoperative analgesia in infra umblical surgeries. Addition of dexamethasone as an adjuvant prolongs the duration and reduces post-operative analgesic requirement in patients significantly more than dexmedetomidine whereas dexamethasone provides better control of the heart rate and mean arterial pressure.

Comparison of Postoperative Analgesia Between Intrathecal Nalbuphine and Intrathecal Fentanyl in Infraumbilical Surgeries: A Double-Blind Randomized Controlled Trial.

Spinal anesthesia is a widely used regional anesthesia technique for surgeries below the umbilicus, butpostoperative analgesia is of major concern due to the relatively short duration of the local anesthetic. Various drugs were used as an additive to local anesthetic to prolong the duration of postoperative analgesia. This study aims to compare the efficacy ofnalbuphine and fentanyl as an intrathecal additive along with local anesthetic. A total of 166 patients aged between 18 and 65 years belonging to the American Society of Anesthesiologists(ASA) I and II undergoing elective infraumbilical surgeries were included in the prospective double-blind randomized controlled trial. The patients were allocated into two groups of 83 each. Group N was given 2.5 mL of 0.5% bupivacaine + 1 mg of nalbuphine (0.5 mL), and group F received 2.5 mL of 0.5% bupivacaine + 25 mcg fentanyl (0.5 mL). Both groups were compared for postoperative analgesia, onset and duration ofboth sensory and motor blockade, intraoperative hemodynamics, and side effects. All demographic data, hemodynamic parameters, and side effects were not statistically significant among the two groups. However, other parameters, such as the mean duration of analgesia, which was 267.27 ±172.099 minutes in group N and 161.35 ±14.957 minutes in group F; meantime for the onset of sensory blockade, whichwas 3.94 ±1.769 minutes in group N and 5.94 ±0.929 minutesin group F; onset of complete motor blockade, which was 7.10 ±1.858 minutes in group N and 11.61 ±1.218 minutes in group F; duration of motor blockade, which was 182.57 ±13.011 minutes in group N and 112.53 ±7.389 minutes in group F;and mean time taken for two-segment regression, which was 118.20 ±12.61 minutes in group N and 113.72 ±8.84 minutes in group F, were all comparable between the two groups. Nalbuphine was found to be more efficacious for prolongation of postoperative analgesia with better hemodynamic stability.

The Efficacy and Safety of Spinal Anesthesia With Hyperbaric Ropivacaine 0.75% and Bupivacaine 0.5% in Patients Undergoing Infra-Umbilical Surgeries: A Randomized, Double-Blind Study.

Spinal anesthesia utilizing hyperbaric 0.75% ropivacaine has been gaining clinical acceptance recently. It is a pure S-enantiomer of bupivacaine, which is expected to have a better clinical profile, but the studies for the same are yet limited. We aimed to compare the efficacy and safety of these two drugs. Sixty patients, aged 18 to 60 years of either sex, classified as American Society of Anesthesiologists class I and II, who were undergoing elective infra-umbilical surgery, were randomly assigned to receive either 3 mL of 0.5% bupivacaine heavy or 3 mL of 0.75% ropivacaine heavy intrathecally. Efficacy parameters, including the onset and duration of sensory and motor block, time to rescue analgesia, hemodynamics, and safety in terms of complications, were recorded. We compared the data for statistical significance, considering a p-value of less than 0.05 as significant. Ropivacaine exhibited a slower onset for both sensory (153.90 ± 6.53 versus 92.46 ± 12.16 seconds; p < 0.001) and motor blockades (301 ± 6.62 versus 239.96 ± 6.27 seconds; p < 0.001). Two-segment sensory and motor blockade regression were faster with ropivacaine compared to bupivacaine (p < 0.001). However, the mean duration of sensory blockade for ropivacaine compared to that for bupivacaine (219.29 ± 15.14 versus 227.31 ± 17.20 minutes) and the requirement for rescue analgesia were not statistically different (p > 0.05). Ropivacaine also caused fewer side effects on a percentage scale. In patients undergoing infra-umbilical surgery, hyperbaric ropivacaine at an equipotent dose (0.75%) proved to be a comparable and safer alternative to hyperbaric bupivacaine (0.5%). Furthermore, it had better motor-recovery profiles.

Comparison of post-operative analgesia with caudal Ropivacaine and Levobupivacaine in pediatric patients undergoing infraumbilical surgery under general anaesthesia

Post-operative pain relief following pediatric abdominal surgery is of paramount consideration and caudal block is still a popular, easy as well as safe analgesic technique for effective analgesia in children. With the advent of newer local anaesthetics, there has been a renewed interest in pediatric caudal blocks after lower abdominal surgeries following general anaesthesia. The aim of our study was to compare the efficacy and duration of postoperative analgesia using caudal Ropivacaine and Levobupivacaine in pediatric patients undergoing infraumbilical surgery under general anaesthesia.: The study was conducted on sixty, ASA grade 1, pediatric patients of age 2 to 6 years, of either sex, posted for elective infraumbilical surgery under general anaesthesia. They were randomly divided in two groups of 30 patients each. Group 1: - (n = 30) received caudal block with injection Ropivacaine, 0.25%, 1ml/kg. Group 2: - (n = 30) received caudal block with injection Levobupivacaine, 0.25%, 1ml/kg. Comparative, randomized, single blinded, observational study. : The demographic data was comparable in both the groups. Postoperatively, the quality of analgesia was assessed by the MOP (Modified Objective Pain Scale) score. Duration of postoperative analgesia was assessed by noting the time of giving rescue analgesia in the post-operative period. We also noted side effects, if any in both the groups. The quality of analgesia was found to be similar with both the drug groups (p value &amp;#62;0.05). The duration of analgesia was longer and statistically significant (p value = 0.0006) in the Ropivacaine group (8.43 ± 0.77 hours) as compared to the Levobupivacaine group (7.03 ± 2.03 hours). Statistically significant difference (P value = 0.026) was seen in the requirement rescue analgesia between Ropivacaine (3.33%) and Levobupivacaine (26.67%) groups. There were no major side effects in either of the groups, apart from a single patient out of 30 patients of Levobupivacaine group who had vomiting, compared with none in the Ropivacaine group.We conclude that caudal block with 0.25% Ropivacaine has a longer duration of action as compared to 0.25% Levobupivacaine in children undergoing infraumbilical surgery under general anaesthesia. Both Ropivacaine and Levobupivacaine, have similar quality of postoperative analgesia and side effect profile.

Comparison of 0.5% Hyperbaric Bupivacaine with Midazolam Versus 0.5% Hyperbaric Bupivacaine Alone Intrathecally: Prospective Observational Study

Context: Neuraxial anesthesia is the preferred choice for infraumbilical surgeries due to its advantages. The incorporation of midazolam alongside local anesthetic drugs in spinal anesthesia has demonstrated positive outcomes. This study was undertaken to assess the effectiveness of midazolam in terms of analgesic and anesthetic efficacy, as well as potential adverse effects, in patients undergoing infraumbilical surgeries. Aims: To compare the analgesic and anaesthetic effect of mixture of midazolam - bupivacaine as compared to bupivacaine alone in patients undergoing infra-umbilical surgeries under spinal anaesthesia. Settings and Design: The present study is a prospective, observational study. Methods and Material: Fifty patients posted for elective infra-umbilical surgery were randomly divided into two groups of 25 each for intrathecal drug administration. (n=25). After administration of block, patients were assessed for analgesic and anesthetic effect of the drug. Statistical Analysis used: The study analyzed through the statistical programming software SPSS-22 and it involved the application of the student’s t-test, with a significance threshold set at a P value of &lt;0.05. Results: Analgesic duration of patients in Midazolam Group was signiÞcantly longer compared to Bupivacaine Group for sensory block. More patients in the midazolam group were sedated and easily arousable. Conclusions: This study concludes that the addition of intrathecal preservative-free midazolam to hyperbaric bupivacaine improved intra - operative anaesthesia and prolonged duration of analgesia. Also, it was observed that there was a significant reduction in the consumption of analgesics during the postoperative period in patients undergoing infra-umbilical surgeries without causing any significant haemodynamic changes.

Tramadol - A Better Alternative to Clonidine as an Additive Agent to Ropivacaine for Postoperative Analgesia in Below Umbilical Surgeries

Abstract Background: Epidural anesthesia is commonly used for providing both postoperative analgesia in infra umbilical surgeries. An adjuvant increases the effectiveness of the local anesthetic drug by prolonging its action and also causes decreased doses of the local anesthetic agent. Aims: The sight and focus of our study are to juxtapose the effect of clonidine and tramadol as an additive to epidural ropivacaine for postoperative analgesia. Materials and Methods: A randomized, concurrent cohort, prospective study was performed on 60 patients (American Society of Anesthesiologists [ASA] Grade I and ASA Grade II) of either gender, those who were planned for chosen elective infraumbilical surgery under combined spinal epidural anesthesia, and divided into two groups. The patients in Group I were administered 15 mL 0.5% ropivacaine + clonidine (2 μg/kg), whereas Group II patients received 15 mL 0.5% ropivacaine + tramadol (2 mg/kg). Postanesthesia vitals, the duration for motor and sensory effects, i.e., block, adverse effects, and time to rescue analgesia, was recorded. Results: A significant decrease in the heart rate was observed in clonidine group patients compared with tramadol group patients after spinal anesthesia. The duration of motor and sensory block in the tramadol group was significantly longer. Time to rescue analgesia was also prolonged significantly in the tramadol group. The incidence of adverse effects was comparable in the two groups. Conclusion: Tramadol, as an additive to epidural ropivacaine, was found to have a better motor and sensory block, prolonged postoperative analgesia, and minimal adverse side effects. A significantly decreased demand for rescue analgesics was seen compared to clonidine.

EFFECT OF ONDANSETRON IN MITIGATION OF POST-OPERATIVE SHIVERING IN COMPARISON TO FORCED AIR WARMER AND DEXAMETHASONE IN PATIENTS UNDERGOING INFRA UMBLICAL SURGERIES UNDER SUBARACHNOID BLOCK - A PROSPECTIVE RANDOMISED STUDY

Background: Subarachnoid block in a ubiquitous technique used in the field of anaesthesia to facilitate any number of surgeries below the level of the umbilicus. However, this technique is frequently associated with post anaesthesia shivering caused by the sympathetic blockade and peripheral vasodilatation. Materials and Methods:We compared the efficacy of Ondansetron against dexamethasone and isolated forced air warming in the mitigation of sub arachnoid blockade induced shivering. We enrolled a total of 120 individuals scheduled to undergo elective infra umbilical surgeries and randomly allocated them into three groups designating each other to receive Dexamethasone (Group D), Ondansetron (Group O) and Forced air warming (Group W). we compared the three group inn respect to pre operative and post operative temperature and onset of shivering. Shivering was graded according to the Crossley Mahajan Scale. Results: We found that the statistical analysis yielded comparable results in term of demographic parameters and no statistical significance among the three group with respect to mitigation of Shivering(Chi square value = 8.5, P = 0.075).

To evaluate the analgesic efficacy of intravenous dexamethasone as an adjuvant to caudal block: A prospective, randomized, double-blind study

Background: Post-operative pain is of great concern in pediatric age group. Intravenous dexamethasone has been found to be promising in reducing post-operative pain when administered as an adjuvant to epidural anaesthesia in abdominal and orthopedic surgeries. However, little is known about its efficacy in children receiving caudal block for post-operative pain relief. Aims and Objectives: This study aimed to evaluate the analgesic efficacy of intravenous dexamethasone as an adjuvant to caudal block in children posted for infraumbilical surgeries. Materials and Methods: This interventional, double-blinded, randomized controlled study included 110 children aged 1–5 years with American Society of Anesthesiologists Grade I and II undergoing elective infraumbilical surgeries. To test our hypothesis, the superiority of intravenous dexamethasone was compared with the control group. All children received caudal bupivacaine 0.25% (1 mL/kg). Children were randomly allocated to two groups to receive: normal saline 0.075 mL/kg (Group C) and IV dexamethasone 0.3 mg/kg (0.075 mL/kg) (Group D). Post-operative pain scores (Face, Legs, Activity, Cry, and Consolability [FLACC] score), duration of analgesia, post-operative analgesic consumption, and intraoperative hemodynamics were compared. Results: FLACC score was found to be higher in Group C than Group D at all times. The mean FLACC score was significantly less with the study drug compared to the control group (P&lt;0.001). The time to request for first rescue analgesia was significantly less in Group C as compared to Group D (4.01±0.69 h vs. 5.51±0.50 h, P=0.019). The mean total analgesic consumed in the first 24 h was significantly higher in Group C than in Group D (666.09±174.69 mg vs. 384.55±125.04 mg, P=0.015). Hemodynamic parameters were comparable in both the groups. Conclusion: Intravenous administration of dexamethasone 0.3 mg/kg as an adjunct to caudal bupivacaine 0.25% provides significantly longer duration of post-operative analgesia and lesser total analgesic consumption compared to the use of caudal bupivacaine 0.25% alone.

Comparative Study between Intravenous and Intrathecal Dexmedetomidine in Spinal Anaesthesia in Patients Undergoing Elective Infra-Umbilical Surgery: The Effect on Haemodynamic Parameters and Postoperative Analgesia

Abstract Background One of the main objectives of anaesthesia is to alleviate the patient’s pain and agony, by ensuring the performance of surgical procedures without any discomfort. Elimination of postoperative pain is indispensable due to the central, peripheral and immunological stress response to tissue injury. So there is a need for extended analgesia without any side effects to achieve this goal. The use of opioids in intrathecal or epidural anaesthesia has become common to increase postoperative analgesia. However, opioid-induced side effects, such as respiratory depression, nausea, vomiting, urinary retention and pruritus, limit their use. Objective The objective of this study was to compare the efficacy of intrathecal dexmedetomidine as an adjuvant to hyperbaric bupivacaine to the intravenous route in patients who are undergoing elective infra-umbilical surgeries under spinal anaesthesia. The duration of analgesia and effect on haemodynamic parameters were evaluated. Moreover, undesirable side effects along with the effect on Ramsay sedation score were studied. Patients and Methods The purpose of this study was to evaluate the effect of intravenous versus intrathecal dexmedetomidine with subarachnoid anaesthesia in patients undergoing elective infraumbilical surgery. The duration of analgesia and effect on haemodynamic parameters were compared. Moreover, undesirable side effects along with the effect on Ramsay sedation score were studied. Hundred patients were randomly allocated into two equal groups (50 patients): group (A) and group (B). Group A received 3 ml of bupivacaine 0.5% plus 0.5 ml of normal saline (Total volume: 3.5 ml) along with 1µg/kg intravenous dexmedetomidine 10 minutes before the blockade. Group B received 3 ml of bupivacaine 0.5% plus intrathecal 5 µg dexmedetomidine (Precedex ©) diluted in normal saline up to the volume of 0.5 ml (Total volume: 3.5 ml). Results The results of the study revealed that the duration of the motor blockade was significantly longer in intrathecal than intravenous group (253.80 ± 20.94 vs. 205.00 ± 19.08; P &amp;lt; 0.001). Also, the duration of the recovery time of sensory blockade in the intrathecal group was significantly longer than those of the intravenous group (230.48 ± 17.21 vs. 181.48 ± 21.12; P &amp;lt; 0.001). The incidence of bradycardia was equivalent in both the groups. Although, the incidence of hypotension was greater in Group A (34.0%) in comparison to Group B (26.0%), it was not statistically significant (P &amp;gt; 0.05). Pain intensity especially at t6 and t12 was significantly lower in the intrathecal group as compared with the intravenous group (3.5 versus 5 at t6 and 2 versus 3 at t12, respectively). Intravenous dexmedetomidine provided a higher intraoperative sedation level and both routes provided a similar sedation level in the postoperative period. The mean dose of diclofenac consumption over a period of 24 h was less in the intrathecal group as compared to the intravenous group (100.30 ± 21.63 mg vs. 135.80 ± 23.02 mg respectively, P = 0.000) Conclusion Intrathecal dexmedetomidine prolonged the duration of sensory and motor blockade along with the postoperative analgesia, compared to IV dexmedetomidine without any significant adverse effects and hemodynamic perturbation. So, we concluded that the addition of 5 µg dexmedetomidine as an adjuvant to 0.5% hyperbaric bupivacaine intrathecally can be a better alternative to provide a satisfactory and longer duration of analgesia as compared to IV dexmedetomidine.

Comparison of Clinical Performance of C-MAC Video Laryngoscope Guided vs Blind Placement of I-Gel® in Paediatric Patients: A Randomized Controlled Open-Label Trial.

Placement of the supraglottic airway devices under direct vision has been shown to decrease the incidence of malposition in adults. This study was designed to compare the clinical performance of C-MAC guided and blind placement of i-gel® in paediatric patients. The present prospective, randomized controlled study was conducted on 102 paediatric patients scheduled to undergo elective infraumbilical surgeries under general anaesthesia. Patients were randomly divided into group "B" (blind) and group "C" (C-MAC) based on the technique used for placement of i-gel®. The primary objective of the study was to compare the incidence of malposition based on the fiberoptic bronchoscope (FOB) score of the glottic view. Oropharyngeal leak pressure (OPLP), hemodynamic parameters, and insertion characteristics (time taken to insert and the number of attempts) were secondary objectives. Categorical data were presented as ratio or percentage and continuous data were presented as mean ± standard deviation or median [95% confidence interval (CI)]. The incidence of malposition (Brimacombe score 1 or 2) was significantly lower in group C compared to group B (7.8% vs 49% respectively) (P < 0.001); implying a relative risk reduction of 2.42 (95% CI 1.72 to 3.40) with C-MAC. On FOB assessment, the median (interquartile range) Brimacombe score was significantly better in group C [4 (4-4)] compared to group B [3 (2-3)] (P < 0.001). The OPLP was significantly higher in group C compared to group B. Other insertion characteristics were comparable in both the study groups. Compared to blind placement, C-MAC guided placement ensures proper alignment of i-gel® with periglottic structures and proper functioning of i-gel®.

A double-blinded randomized control trial to compare the duration of analgesia using morphine, clonidine, or dexmedetomidine as adjuvants to ropivacaine in caudal anesthesia in children undergoing infraumbilical surgeries

Background and Aims: Adjuvants added to the caudal block prolong the duration of analgesia. In a developing country with economic constraints, the choice of an adjuvant will be the medication with a longer duration of analgesia, a favorable side-effect profile, and the least expensive option. We wished to study the duration of postoperative analgesia afforded by three adjuvants: morphine, clonidine, and dexmedetomidine, at doses wherein minimal or nil adverse effects would be attributed to the adjuvant. The primary objective of the current study is to compare the duration of postoperative analgesia with morphine, clonidine, or dexmedetomidine as adjuvants to 0.2% ropivacaine in a for caudal block, in children undergoing elective abdominal, urogenital, and lower limb surgeries. The secondary objectives are (a) to study the total analgesic requirement during the first 24 hours after surgery and (b) to compare the incidence of complications among the three groups. Material and Methods: Sixty-three children aged 1–6 years, belonging to American Society of Anesthesia (ASA) physical status I, II, and scheduled to undergo elective infraumbilical surgeries, were enrolled in the study. The children were randomly assigned to one of three groups: Group D received a caudal block with dexmedetomidine 1 μg/kg, Group M received morphine 30 μg/kg, and Group C received clonidine 1.5 μg/kg. All groups also received 0.2% ropivacaine (1–1.25 ml/kg) as part of the caudal block. The duration of analgesia, total analgesic requirements during the first 24 hours after the surgery, and the incidence of complications in the three groups were monitored by a pain nurse who was blinded to the study allocation. Results: The three groups were comparable with respect to age, sex, weight, and duration of surgery. The median time taken for the first rescue analgesic in the dexmedetomidine group was 380 minutes, in the clonidine group was 360 minutes, and in the morphine group was 405 minutes. Though the morphine group had a longer duration of analgesia, it was not statistically significant (P = 0.843). The total perioperative opioids used and side effects were similar among the three groups. There were no episodes of intraoperative bradycardia noted in Groups D, M, and C. However, one patient in Group D required treatment for bradycardia in the postanesthesia care unit. In terms of intraoperative hypotension, 10 patients (43.5%) in Group D, 5 patients (27.8%) in Group C, and 5 patients (22.7%) in Group M required treatment, but this difference was not statistically significant (P = 0.299). There was no significant difference observed in the time to awakening after the anesthesia among the three groups. Postoperative nausea and vomiting were noted in five patients (21.7%) in Group D, one patient (5.6%) in Group C, and four patients (18.2%) in Group M (P = 0.382). One patient in Group M had a sedation score of 5 and required 4 hours of supplemental oxygen via face mask in the ward. Additionally, one patient in Group D reported numbness in both feet lasting 12 hours with spontaneous resolution. While a significant number of patients in all three study groups experienced urinary retention, no patient reported pruritus in the ward. Conclusion: Caudal administration of morphine, dexmedetomidine, and clonidine in children undergoing infraumbilical surgery resulted in an equivalent duration of analgesia.

COMPARISON OF 0.5% LEVOBUPIVACAINE- FENTANYLAND 0.5% ROPIVACAINE-FENTANYL IN INFRAUMBILICAL SURGERIES

Spinal anaesthesia is a commonly performed procedure when the surgical site is located on the lower abdomen, perineum or lower extremities. The advantages are an awake and spontaneously breathing patient, minimal drug costs, reduction of poly-pharmacy and rapid patient turnover. Regional anesthesia techniques have seen numerous modifications over the last two decades with the advent of many new and safer local anesthetics. Presently, hyperbaric bupivacaine is the most commonly used drug for administration of spinal anaesthesia. Levobupivacaine and ropivacaine have recently become available in India for clinical use. Very few studies have been done comparing these two drugs in India. Hence, present study was undertaken to compare 0.5% Levobupivacaine (isobaric)-fentanyl(25µg) and 0.5% Ropivacaine (isobaric)-fentanyl(25µg)with regards to onset and duration of blockade infra umbilical surgeries in spinal anaesthesia. Methods and materials- this is a hospital based randomized double blinded comparative clinical study. Adult patients scheduled for elective infra umbilical surgeries under spinal anaesthesia. Eighty patients were randomized to two groups: group LF and RF (n=40 for each group). All patients received drug volume of 3.5ml containing 3 ml isobaric levobupivacaine (15 mg) + 0.5 ml (25 mcg) fentanyl in group LF, and 3ml isobaric ropivacaine (15mg) + 0.5 ml (25 smcg) fentanyl in group RF. The time for completion of intrathecal administration of study drugs injection is considered as TIME 0. The following parameters were observed – time of onset and duration of sensory block, motor block. Results: In the present study, mean onset of sensory block was faster in Group LF (5.25±0.74 min) than in Group RF (6.53 ± 0.51 min) and was statistically significant (p value &lt; 0.001). In the present study, mean onset of motor block was faster in Group LF (7.25±0.98 min) than in Group LF (11.2 ± 0.61 min) and was statistically significant (p value &lt;0.001). Conclusion: LF group provided better sensory and motor blockade with higher dermatome coverage than RF group.

A Comparative Study of Intravenous Magnesium Sulphate Versus Intrathecal Magnesium Sulphate in 0.5% Hyperbaric Bupivacaine Spinal Anaesthesia for Elective Infraumbilical Surgery

BACKGROUND&#x0D; In this study, we wanted to compare the characteristics of subarachnoid block when intrathecal versus intravenous magnesium sulphate was used with 0.5 % hyperbaric bupivacaine spinal anaesthesia in elective infraumbilical surgery.&#x0D; METHODS&#x0D; This was a hospital based prospective randomized clinical parallel arm study double-blinded (patient and observer blinded) single hospital study conducted among 100 patients who presented with elective infraumbilical surgery under spinal anaesthesia to the Department of Anesthesiology and Critical Care, Gauhati Medical College and Hospital, Guwahati, from 1st June 2021 to 31st May 2022 after obtaining clearance from the institutional ethics committee and written informed consent from the study participants.&#x0D; RESULTS&#x0D; The onset of sensory block, and comparison of duration of analgesia with respect to time to first analgesic request was found to be statistically significant. While comparing, duration of analgesia was significantly prolonged in the intravenous group. Magnesium administered intravenously or intrathecally was not linked to any harmful side effects.&#x0D; CONCLUSIONS&#x0D; Infraumbilical procedures that use intravenous magnesium sulphate as an adjuvant to 0.5% hyperbaric bupivacaine spinal anaesthetic extend the time that post-operative analgesia lasts. Intrathecal co-administration of Magnesium sulphate with 0.5% hyperbaric bupicavaine delays the onset of sensory block compared to intravenous MgSO4.

Comparison of intrathecal bupivacaine with different doses of clonidine for spinal anesthesia in adults: A systematic review

Background: Evaluating the optimal dose of intrathecal clonidine adjuvant has a great impact on day-to-day practice of anesthesia, as spinal anesthesia is one of the most commonly performed anesthetic procedure.Objectives: Evaluate for the minimal dose of intrathecal clonidine as an adjunct to bupivacaine heavy for spinal anesthesia that can produce optimal sensory and motor blockade with minimal hemodynamic effects.Methods: Randomized control trials carried out on adult patients, of both genders undergoing elective infraumbilical surgeries under spinal anesthesia with bupivacaine heavy and different doses of clonidine having ethical committee approval were included and articles published in non-English languages were excluded. Databases (PubMed and Google Scholar) and websites of the Indian Journal of Anaesthesia and anesthesia essays and researches journals were systematically searched and interpreted in accordance with the PRISMA guidelines. Quality assessment was done using the Risk of Bias assessment 2.O tool. The mean time taken for the onset of sensory and motor blockade, mean duration of sensory and motor blockade and significant adverse effects were the key outcome variables. Nonstatistical synthesis of quantitative data of the selected articles was done.Results: The efficacy in terms of sensory and motor blockade was comparatively more with 1 μg/kg of intrathecal clonidine than with lower doses, however, cardiovascular adverse effects were dose-dependent, with 15 μg intrathecal clonidine causing least cardiovascular disturbance.Conclusion: 15–30 μg intrathecal clonidine as an adjunct to bupivacaine heavy would produce optimal sensory and motor block with minimal hemodynamic disturbances.

Low Dose Bupivacaine (0.25%) with Fentanyl vs Ropivacaine (0.25%) with Fentanyl for Caudal Analgesia in Paediatric Patients: A Randomised Clinical Study

Introduction: Caudal epidural block is one of the most common regional techniques in paediatric anaesthesia for infraumbilical surgeries. Though bupivacaine is widely used because of its long duration, ropivacaine is a newly emerging drug having differential neuraxial blockade with less motor block and reduced cardiovascular and Central Nervous System (CNS) toxicity. To further increase the duration and quality various adjuvants have been added. Aim: To compare low dose bupivacaine-fentanyl with ropivacaine-fentanyl in terms of hemodynamic stability, duration of analgesia, postoperative pain, level of sedation, and side-effects profile among patients undergoing infraumbilical surgery. Materials and Methods: A double-blind, randomised study was conducted on 60 children undergoing elective infraumbilical surgery. Patients were randomly divided into two groups of 30 each into Bupivacaine-Fentanyl (BF) group and RopivacaineFentanyl (RF) group, using a simple envelope method. After securing airway, caudal block was given. Group BF received 0.25% bupivacaine 0.5 mL/kg with fentanyl 0.5 mcg/kg and Group RF received 0.25% ropivacaine 0.5 mL/kg with fentanyl 0.5 mcg/kg. Postoperative pain was assessed using the Face, Legs, Activity, Cry, Consolability (FLACC) pain assessment scale, for 12 hours. The hemodynamics, duration of analgesia, rescue analgesia requirement and side effects (bradycardia, hypotension, respiratory depression, retching, urinary retention, vomiting) were noted and analysed statistically. Results: The mean duration of analgesia in the BF group was 270±46.60 minutes and in the RF group was 430±68.83 minutes (p-value &lt;0.001). Patients requiring rescue analgesia were 12 in Group BF and 5 in Group RF. Mean FLACC reached ≥4 at 4.5 hours in group BF and at 7 hours in group RF. There was no significant difference in hemodynamics and side-effects profile (bradycardia, hypotension, respiratory depression, retching, urinary retention, vomiting) between the two groups. Conclusion: Low dose caudal ropivacaine-fentanyl combination is superior to that of caudal bupivacaine-fentanyl with respect to duration and intensity of intraoperative and postoperative analgesia.

Cardiovascular Effects of Adding Epinephrine to Bupivacaine in Children Undergoing Caudal Block: A Double-blind Randomized Clinical Trial

Background: Caudal block is a common, safe, and effective anesthetic technique for lower abdominal, urological, and lower extremity surgeries in pediatrics. Objectives: This study aimed to evaluate the cardiovascular effects of adjuvant epinephrine in the caudal block on heart rate and blood pressure changes in children. Methods: This double-blind, randomized clinical trial was performed on 60 children who underwent elective infra-umbilical surgeries. They were under general anesthesia with midazolam, fentanyl, lidocaine, and propofol. The patients were ventilated through laryngeal mask airway (LMA), and anesthesia was maintained with sevoflurane in O2 and N2O mixture. The intervention group received a caudal block with 0.2% bupivacaine and 1/200000 epinephrine (1 mL/kg), while the control group received a caudal block without epinephrine. Heart rate, blood pressure, and ECG were monitored before the block and in the first, fifth, and 20th minutes after surgery. Results: The two groups showed no statistically significant differences in demographics and systolic and diastolic blood pressures. However, sinus arrhythmia was more prevalent in the study group in the first minute after the block (P &lt; 0.001). No differences were observed in the incidence of arrhythmia in the fifth and 20th minutes after the block. Conclusions: It appears that epinephrine as an adjuvant to the caudal block does not have long-lasting effects after the block, except sinus tachycardia in the first minute. Considering that no changes in blood pressure and other hemodynamic parameters were observed, it seems that epinephrine can be used safely in the caudal block in pediatric patients.

Arousal Time from Sedation during Spinal Anaesthesia Given with Propofol and Midazolam for Elective Infraumbilical Surgeries

Background: Arousal time is variable after sedation with spinal anesthesia after infraumbilical surgeries. Propofol and midazolam have been studied individually using the Observer’s Assessment of Awareness/Sedation (OAA/S) score and different other ways. So this present study was designed to compare the arousal time of sedation for propofol and midazolam using OAA/S scores.&#x0D; Materials and methods: A total of 60 patients were randomly assigned to receive either propofol (Group A, n =30) or midazolam (Group B, n = 30). All patients of Group A received bolus of propofol (1 mg/kg) followed by infusion at 3 mg/kg/h, Group B received bolus of midazolam (0.05 mg/kg), followed by infusion at 0.06 mg/kg/h. OAA/S score was noted at beginning and again during recovery. The time to achieve OAA/S score 5 was noted. Changes of pulse rate, O2 saturation and satisfaction score were noted.&#x0D; Results: Among the 60 patients gender distributions where male and female distributed evenly. Age group distributions revealed more patients were gathered in age group 31- 40 years and &gt;51 years. Regarding physical status most of the patients were at ASA physical status 1. It was found that propofol had better outcome than midazolam in terms of arousal time score and patient’s satisfaction score after surgery.&#x0D; Conclusions: A shorter arousal time from sedation during spinal anaesthesia can be achieved using propofol than arousal time with midazolam.&#x0D; Chatt Maa Shi Hosp Med Coll J; Vol.21 (2); July 2022; Page 18-21

Comparison of onset and duration of sensory and motor blockade with intrathecal isobaric bupivacaine versus isobaric levobupivacaine for infraumblical surgeries

Background: Spinal anaesthesia remains a popular technique of choice for performing surgeries on abdomen, pelvis and lower limbs. It has fast onset of action and provides effective sensory and motor blockade. Spinal anaesthesia is routinely performed by administration of 0.5% bupivacaine. Aims: Aim of the study was to compare onset and duration of sensory and motor blockade between intrathecal isobaric 0.5% bupivacaine and isobaric 0.5% levobupivacaine. Materials and methods: 80 patients between the age group of 18-65 years of either gender, belonging to ASA Grade I and II scheduled for elective infraumbilical surgeries were enrolled in the study. They were randomised into 2 groups. Group B received intrathecal 3.2 ml of 0.5 % isobaric bupivacaine and Group L received intrathecal 3.2 ml of 0.5% isobaric levobupivacaine. Onset and duration of sensory and motor blockage were compared between the two groups.