Epidural Bupivacaine Research Articles

A Comparative Study Of Caudal Epidural Bupivacaine And Midazolam-Bupivacaine Mixture For Post-Operative Analgesia In Children Repairing Congenital Inguinal Hernia

Background: Managing postoperative pain in pediatric anesthesia is challenging, with caudal epidural anesthesia being a preferred technique for its safety and efficacy. Enhancing analgesia duration through adjuvants like midazolam may improve outcomes. Objective: This study compares the effectiveness of caudal epidural bupivacaine alone versus a bupivacainemidazolam mixture in children undergoing repair of congenital inguinal hernia, circumcision, and hypospadias repair, focusing on postoperative analgesia duration and side effects. Materials and Methods: A double-blind randomized controlled trial was conducted at Islami Bank Medical College Hospital from October 2023 to March 2024, involving 50 children aged 2-8 years, divided into two groups: Group A (bupivacaine-midazolam) and Group B (bupivacaine alone). Pain was assessed using the FLACC scale at specified intervals up to 24 hours post-surgery. Results: Group A experienced significantly longer postoperative analgesia (10.72 ± 4.07 hours) compared to Group B (6.13 ± 1.98 hours). Mild pain was more common in Group A (72.7%) than Group B (87.5%), while moderate pain was higher in Group A (27.3%) than Group B (12.5%). Side effects were minimal, with Group A having no side effects and Group B experiencing 8% nausea and vomiting and 4% other side effects. Conclusion: The addition of midazolam to caudal bupivacaine significantly prolongs postoperative analgesia and reduces the need for rescue analgesia in children, with minimal side effects

Perioperative epidural catheter analgesia as a component of a multimodal analgesic approach in a dog with thoracic hemivertebrae and kyphosis undergoing thoracic vertebral stabilisation

AbstractA 4‐year‐old, male, neutered French bulldog weighing 13.5 kg presented with urinary and faecal incontinence, progressive, non‐painful paraparesis and pelvic limb proprioceptive ataxia. Magnetic resonance imaging revealed a T12 constrictive myelopathy in association with multiple thoracic vertebral malformations, and mildly impinging thoracic intervertebral disc protrusions. Additionally, there was a sacral axial defect and degenerative lumbosacral stenosis. Surgical treatment comprised bilateral dorsal vertebral stabilisation of T9–T13. This case report summarises the peri‐anaesthetic management, which included an ‘in‐plane’ ultrasound‐guided placement of an epidural catheter at the level of L3–L4 and advancement cranially to T12 as a component of a multimodal analgesic regimen. Following the cessation of postoperative epidural bupivacaine administration, the patient remained comfortable without requiring rescue analgesia, and was discharged within 24 hours of surgery. At the latest recheck 5 months after surgery, the dog's neurological status remained static. This technique and application remain unexplored in existing veterinary literature.

Perioperative analgesic management in patients with bladder exstrophy: A clinical study

Background: Bladder exstrophy is a complex, rare congenital malformation with an incidence of 3.3 cases in every 100000 live births and is slightly more common in males. Primary surgical repair requires many hours of surgery with fluid and blood loss. Because of wide fluctuations in hemodynamics, a longer duration of surgery, smaller age, risk of hypothermia and post-operative intensive care may be required. We evaluated the use of continuous caudal epidural infusion of bupivacaine and fentanyl under general anesthesia for urinary bladder exstrophy-epispadias surgery in children. Aims and Objectives: Aim of the study was to evaluate the postoperative analgesia in patients undergoing surgery for bladder exstrophy. The primary objective was to assess the postoperative pain using FLACC scale and sedation score after successful caudal administration. Secondary objective was to assess the hemodynamic changes after caudal administration. Materials and Methods: A total of 13 patients aged between 9months and 13 years of either sex, weighing between 5kg to 30kg, belonging to ASA grade II to IV, underwent surgery for epispadias–exstrophy complex. Initial bolus 0.75ml/kg of 0.25% bupivacaine with fentanyl 1ug/kg was given through epidural. Postoperative analgesia was maintained by continuous infusion of 0.0625% bupivacaine @0.1ml/kg/hr in young children and 0.125% bupivacaine with fentanyl 1ug/ml in older children for 4-5 days with the help of ON-Q pump or infusion pump. Baseline hemodynamic parameters including MAP, heart rate and SpO2 was recorded at various time intervals. Postoperative pain was assessed using face, legs, activity, cry and consolability (FLACC) pain scale and sedation score was assessed by using ramsay sedation score. Results: There was a statistically significant decrease in mean pulse rate in the study group from baseline to thirty minutes after reversal (p<0.001). Similar observation was made for mean arterial pressure which also showed statistically significant decrease from baseline to thirty minutes after reversal (p<0.001). No change was observed in SpO2 from baseline to any other follow-up interval. Conclusion: Perioperative anesthetic and analgesic management of the bladder exstrophy patient can improve the success rate. Epidural bupivacaine with or without fentanyl infusions for short duration can provide safe analgesia.

Epidural nalbuphine versus dexmedetomidine as adjuvants to bupivacaine in lower limb orthopedic surgeries for postoperative analgesia: a randomized controlled trial

BackgroundAdministration of adjuvant drugs epidurally in combination with local anesthetics offers new dimensions in the management of postoperative pain. This study aimed to compare the addition of either nalbuphine or dexmedetomidine to epidural bupivacaine for postoperative analgesia in lower limb orthopedic surgeries under combined spinal-epidural anesthesia.MethodsThis prospective randomized double-blind study included 69 patients scheduled for lower limb orthopedic surgeries. Anesthesia was started with 15 mg hyperbaric bupivacaine 0.5% intrathecally, and then an epidural bolus dose of 12 ml (10 ml 0.25% bupivacaine with 2 ml normal saline in group C, 2 ml (10 mg) nalbuphine in group N or dexmedetomidine 2 ml (100 µg) in group D was administered when sensory regression to T10. Postoperatively, when visual analogue scale (VAS) was ≥ 3, an epidural top-up dose of 8 ml (6 ml 0.25% bupivacaine plus 2 ml normal saline in group C, 2 ml (2 mg) nalbuphine in group N or 20 µg dexmedetomidine (2 ml) in group D was given. The primary outcome was to evaluate the duration of postoperative analgesia and secondary outcomes were any side effects and patient satisfaction.ResultsThe onset of epidural analgesia was 17.83 ± 2.53 versus 13.39 ± 1.27 versus 12.17 ± 1.27 min in groups C, N and D, respectively (p value < 0.001). The mean duration of analgesia was 241.3 ± 14.24 versus 318.38 ± 22.54 versus 365.87 ± 18.01 min in groups C, N and D, respectively (p value < 0.001). The mean sedation score was less in group C than group N and D (P < 0.001). The patient satisfaction score showed the lowest degree of satisfaction in group C (p value < 0.001). Top-up doses consumed and total analgesic requirements were lower in groups N and D than in group C. There was a statistically significant difference between the studied groups regarding VAS over time (p value < 0.001), intraoperative bradycardia (p value 0.029), and shivering (p value 0.029).ConclusionThe addition of either nalbuphine or dexmedetomidine to epidural bupivacaine was effective for postoperative analgesia in terms of onset, duration, and patient satisfaction with the superiority of dexmedetomidine over nalbuphine.Trial registrationApproval from the research ethics committee of the Faculty of Medicine, Zagazig University was obtained with the reference number (ZU-IRB#:7045-15-8-2021) and it was registered under clinicaltrials.gov (NCT05041270) on registration date 13/09/2021.

Effects of midline laparotomy on cough strength: a prospective study measuring cough pressure.

Laparotomy is assumed to decrease cough strength due to three factors: abdominal muscle trauma, postoperative pain, and diaphragmatic dysfunction. However, the effect of trauma from laparotomy itself on strength (net of the other two factors) has not been measured to our knowledge. The aim of this study was to measure the effect of laparotomy on cough strength after first measuring the effect of epidural analgesia. In 11 patients scheduled for open midline laparotomy, cough pressure (PCOUGH), a proxy for strength, was measured with a rectal balloon at three moments: before the procedure, at baseline; before surgery, under epidural bupivacaine to T6; and postoperatively, under epidural bupivacaine to the same analgesic level (T6). Continuous variables were compared using the Wilcoxon signed-rank test. The repeatability of PCOUGH measurements was confirmed with the intraclass correlation coefficient (ICC). Pain on coughing, hand grip strength, and the Ramsay and modified Bromage scores were also recorded. Median (interquartile range) PCOUGH decreased from a baseline of 103 (89-137) to 71 (56-116) cmH<inf>2</inf>O under presurgical epidural bupivacaine (P=0.003). Postoperative PCOUGH remained unchanged at 76 (46-85) cmH<inf>2</inf>O under epidural analgesia (P=0.131). The ICCs indicated excellent repeatability of the PCOUGH measurements (P<0.001). Pain on coughing was 0 to 1 in all subjects. Hand grip strength and the Ramsay and Bromage scores were unchanged. Although thoracic epidural bupivacaine reduces cough strength as measured by PCOUGH, midline laparotomy does not further reduce strength in the presence of adequate epidural analgesia.

Therapeutic efficacy of intravenous lidocaine infusion compared with thoracic epidural analgesia in major abdominal surgery: a noninferiority randomised clinical trial

BackgroundOpen major abdominal surgery is one of the most risky surgical procedures for acute postoperative pain. Thoracic epidural analgesia (TEA) has been considered the standard analgesic approach. In different reports, lidocaine i.v. has been shown to have an analgesic efficacy comparable with TEA. We compared the analgesic efficacy of i.v. lidocaine with thoracic epidural analgesia using bupivacaine in patients undergoing major abdominal surgery. MethodsIn this noninferiority clinical trial, 210 patients were randomised to thoracic epidural bupivacaine with morphine or i.v. lidocaine. Dynamic pain at 24 h after surgery was measured using a numerical pain rating scale (NPR), and morphine consumption was also measured. A difference in i.v. the lidocaine-epidural bupivacaine NPR of ≤1 for dynamic pain was considered a noninferiority margin. ResultsThe NPR for dynamic pain in the lidocaine group at 24 h was between 5.7 (1.8) and 5.2 (1.9) in the epidural group, with a difference of 0.53 (95% confidence interval 0.0–1.0). In the first 24 h, the average difference in morphine consumption was 1.8 mg between the i.v. lidocaine and epidural groups (95% confidence interval 1–3 mg). No differences were found in adverse events or complications associated with the procedures. ConclusionsIntravenous lidocaine is noninferior to thoracic epidural analgesia for acute postoperative pain control in major abdomial surgery at 24 h postoperatively. Clinical trials registrationNCT04017013.

Effect of Epidural Dexmedetomidine vs Nalbuphine for Labor Analgesia: A Randomized Clinical Trial

Abstract Background The addition of dexmedetomidine or nalbuphine to epidural bupivacaine was tested to reduce labor pain in women undergoing normal delivery. Patients and Methods 64 patients were randomly allocated into two groups of 32 parturients each with conscent from parturients. Groups A and B received a bolus of 12 ml volume consisting of 11 ml of 0.25% bupivacaine and 0.5 μg/ml dexmedetomidine (1 ml volume) through the epidural catheter and then a top up dose of 6 ml volume consisting of 5 ml of 0.25% bupivacaine and 0.5 μg/ml dexmedetomidine (1 ml volume) were given when VAS score becomes 4 or more and a bolus of 12 ml volume consisting of 11 ml of 0.25% bupivacaine and 10 mg nalbuphine (1 ml volume) through the epidural catheter and then a top up dose of 5 ml of 0.25% bupivacaine and 2 mg nalbuphine (1 ml volume) respectively. Assessments included VAS score for pain, vital data monitoring, recording of duration of stages of labor, neonatal APGAR score and adverse effects. Results Parturients in both groups had satisfactory labor analgesia, but those in the dexmedetomidine group had lower pain scores than those in the nalbuphine group. Taking into consideration that dexmedetomidine had a faster onset than nalbuphine. Conclusion Epidural dexmedetomidine seems to offer some advantages over epidural nalbuphine. Thus, it can be used effectively and safely as an adjuvant to epidural bupivacaine in labor analgesia.

The Effect of Adding Magnesium Sulphate to Epidural Bupivacaine Compared to the Addition of Fentanyl to Epidural Bupivacaine in Patients Undergoing Lower Limb and Pelvic Orthopedic Surgery under Combined Spinal Epidural Anesthesia

Abstract Background Epidural anesthesia is safe and inexpensive technique with the advantage of providing surgical anesthesia and prolonged postoperative pain relief. Research continues concerning different techniques and drugs that could provide better surgical anesthesia and postoperative pain relief. Aim of the Work to investigate how the addition of magnesium sulphate to 0.5% bupivacaine affects duration, quality, complications and dermatome spread of anesthesia in comparison to fentanyl. Patients and Methods The current study included 50 patients who had been scheduled to undergo lower limb or pelvic orthopedic surgery under combined spinal - epidural anesthesia. The study had been done after approval of the local ethics committee and after obtaining written informed consent from all patients enrolled in the study; which had been held at Ain Shams Hospital, Faculty of Medicine. Results Pain assessment using VAS showed no statistically significant difference between the two studied groups in the first and second hours postoperative. Starting from the third hour statistical significant differences were observed between the two groups, VAS was higher in groups (M) than in group (F); (1.82 ±0.6 vs. 1.42 ±0.4 in both groups respectively. At the fourth hour; VAS was higher in groups (M) than in group (F); (2.80±0.8 vs. 1.76 ± 0.6 in both groups respectively. The incidence of complications was significantly lower among group (M) where 52% of patients had no complications at all. Conclusion the use of both magnesium and fentanyl as adjuvants to local anesthetics in epidural anesthesia is safe and effective. No significant differences regarding quality of motor block and hemodynamics. But the study shows that fentanyl is significantly a better adjuvant regarding postoperative analgesia and time for first analgesic dose. While magnesium is a significantly better adjuvant regarding complications such as nausea, vomiting and pruritis.

Incidence of postoperative administration of opioids in dogs undergoing a tibial plateau leveling osteotomy after intra-operative liposomal bupivacaine administration with or without morphine epidural

ObjectiveTo determine the influence of two intraoperative pain management protocols on the need for additional opioids in patients receiving an epidural and periarticular liposomal bupivacaine (PLB) vs. PLB alone in the 12–24 h period after undergoing a TPLO.Study designRetrospective study.AnimalsOne hundred seventy-four dogs with cranial cruciate ligament tears presenting for TPLO.MethodsMedical records of dogs presenting for a unilateral or bilateral cranial cruciate ligament tear who had a TPLO performed were reviewed for signalment, weight, body condition score, and peri-operative pain management protocol. Dogs were divided into two groups: those who received an epidural and PLB, and those who received only PLB. Post-operative opioid administration was recorded for each group.ResultsPatients who received an epidural and PLB received fewer postoperative opioids. There were 36% fewer opioid injections administered to dogs who received epidurals compared to dogs who did not receive epidurals (IRR) (95% CI) = 0.64 (0.45–0.92), P = 0.02). BCS was not a significant predictor of the post-operative opioid requirement (IRR (95% CI) = 1.3 (0.75–2.4), P = 0.38). When adjusting for BCS as a possible confounder, there were 39% fewer opioid injections in dogs who received epidurals than dogs without (IRR (95% CI) = 0.61 (0.42–0.88), P = 0.009).ConclusionsThe incidence of postoperative opioid administration was significantly diminished in patients receiving both an epidural and PLB.Clinical significanceAdministration of an epidural in addition to infiltration of PLB significantly decreased the incidence of postoperative opioid administration in dogs undergoing a TPLO.

Comparative study between dexmedetomidine and fentanyl as adjuvants to bupivacaine for postoperative epidural analgesia in abdominal surgeries: A randomized controlled trial

ABSTRACT Background Epidural analgesia is an efficient strategy to relieve postoperative pain after abdominal surgeries. This study aimed to evaluate dexmedetomidine or fentanyl when added to bupivacaine, providing postoperative epidural analgesia after abdominal procedures. Patients and methods Epidural catheter was placed on 75 patients scheduled for lower abdominal procedures under general anesthesia, and they were randomly assigned into three equal groups. Epidural analgesia was activated before the procedure was completed by injection of bupivacaine (0.125%) plus dexmedetomidine or fentanyl or normal saline mixture, according to the study groups. After complete recovery from general anesthesia, the epidural block was evaluated. Then, the infusion started through an elastomeric pump with an infusion rate of 5 ml/hr and continued for 24 hr postoperatively. Group D Dexmedetomidine 1 ml (100 μg) plus normal saline 1 ml were added to bupivacaine (0.125%) 48 ml (a total volume of 50 ml). Group F: 2 ml (100 μg) fentanyl was added to bupivacaine (0.125%) 48 ml (a total volume of 50 ml). Group C: Normal saline 2 ml was added to bupivacaine (0.125%) 48 ml (a total volume of 50 ml). Measured outcomes Primary outcomes The onset of sensory analgesia (from the beginning of epidural infusion until scoring 1 on a 3-point scale) and the duration of analgesia (from the start of epidural infusion till the first demand for further pain medication) were observed and recorded. Secondary outcomes Postoperative pain was evaluated using a visual analogue scale (VAS), and the number of patients requesting additional analgesia with pethidine over paracetamol as well as the pethidine consumption during postoperative 24 hr were recorded. The hemodynamic parameters, including heart rate (HR) and mean arterial blood pressure (MAP), were monitored and recorded at baseline, 2, 6, 12, and 24 hr, and any adverse events were properly recorded and managed during the study period. Results The dexmedetomidine group showed an earlier onset and longer duration of analgesia, with a highly significant difference (P-value <0.001) than other groups. The study groups differed significantly concerning pethidine needs and consumption (P-value <0.05). The VAS revealed a considerable decrease in the dexmedetomidine group compared to other groups, with a significant difference (P-value <0.05) at the intervals of (baseline, 12 hr, and 24 hr) and a highly significant difference (P-value <0.001) at the intervals of (2 and 6 hr). Postoperative blood pressure and heart rate measurements in the dexmedetomidine group were lower than in other groups. MAP showed a statistically highly significant difference at 6 and 24 hr (P-value <0.001) and a significant difference after 12 hr (P-value <0.05), while HR showed a statistically significant difference after 6 hr (P-value <0.05) and a highly significant difference at 12 and 24 hr (P-value <0.001). Regarding postoperative adverse events, no statistical difference was detected between groups except in pruritis and dry mouth. Conclusion Dexmedetomidine is preferred to fentanyl when added to epidural bupivacaine to relieve pain after abdominal procedures.

A comparative study between butorphanol and tramadol as adjuvant with epidural bupivacaine for post-operative analgesia after pelvi-acetabular surgery

Epidural analgesia using local anaesthetic agent is popular simple, effective &amp; economical way of providing postoperative analgesia. In few previous study opioids were added with local anaesthetics, so that even small doses can provide profound analgesia of longer duration with less side effects. We compared the efficacy of epidural butophanol with tramadol as adjuvant with bupivacaine, for postoperative analgesia in view of safety profile among opioids. Sixty patients undergoing pelvi-acetabular surgery were randomly assigned into two groups B &amp; T in double blinded fashion. Group B received 2ml Butorphanol (2mg) &amp; group T received 2ml of tramadol(100mg) as adjuvant with 8ml Bupivacaine (0.125%) as first does. 1ml Butorphanol (1mg) in group B &amp; 1 ml Tramadol(50mg) in group T as adjuvant with 9ml Bupivacaine (0.125%) as subsequent does when VAS&amp;#62;4. Quality of analgesia assessed using VAS for 24hours. Duration of analgesia calculated by time of first analgesia request. Post-operative nausea vomiting &amp; sedation compared. Both butorphanol group &amp; tramadol group provide adequate analgesia but significantly lesser requirement of analgesic doses was observed in the group T compared to Group B. Duration of analgesia in Group B was about 6-7 hour &amp; in Group T was about 8-9 hours. More PONV in Group T &amp; more sedation in group B seen. Therefore, it suggests that epidural bupivacaine with butorphanol has better quality of analgesia in comparison with bupivacaine with tramadol. Although bupivacaine with tramadol has longer duration of analgesia but causes significant nausea &amp; vomiting.

Dexmedetomidine and Fentanyl as Adjuvant to Bupivacaine for Epidural Analgesia in Gastrectomy Surgery

Background: Opioids as epidural adjunct to local anaesthetics have been in use so long and the synergism between epidural local anaesthetic agents and opioids are well established. Dexmedetomidine (α-2 agonist) is being increasingly used for similar purpose but evidence for the combination of local anaesthetic agents with dexmedetomidine in epidural analgesia is limited. Gastic cancer is increasing day by day in our country and removal of tumor by gastrectomy surgery is choice of treatment. The present study was conducted to compare the analgesic, hemodynamic, sedative effects of epidurally administered dexmedetomidine and fentanyl when combined with bupivacaine in a patient undergoing gastrectomy surgery along with general anaesthesia.Methods: This randomized controlled trial study was carried out in the Department of Anaesthesia, Analgesia and Intensive Care Medicine, BSMMU, Dhaka. The study was been conducted 12 month after obtaining approval from the institutional Review Board and informed written consent from the patient. About 40 patients aged between 40 and 70 years, posted for gastrectomy surgery were included in this study. The patients were randomly allocated into two equal groups. Group A received general anaesthesia along with epidural fentanyl and bupivacaine. Group B received general anaesthesia along with epidural dexmedetomidine andbupivacaine. During surgery, hemodynamic status of the patients had been carefully recorded. Following surgery, pain intensity was recorded using a visual analog scale (VAS) for 6 hours and observed for the time of first rescue analgesic requirement, post-operative sedation score by Ramsay sedation score, and surgeons satisfaction by likert scale. A statistical analysis was carriedout by using the Statistical Package for Social Sciences version 23.0 for Windows. Chi-Square test used to analyze the categorical variables and student t-test used for continuous variables. P value &lt;0.05 was considered as statistically significant.Results: Age, height, and weight were almost identical between two groups. Duration of surgery and anaesthesia were almost similar between two groups. Systolic blood pressures, diastolic blood pressure, MAP were almost similar between two groups and were statically not significant (p&gt;0.05). Mean heart rate of group B was significantly lower (p&lt;0.05) than that of group A. Post-operative visual analog scale was reduced significantly (p&lt;0.05) in group B than group A. The time of first analgesic requirement was significantly higher (p&lt;0.05) in group B. The mean sedation score was also significantly higher (p &lt; 0.05) in group B than group A.Conclusion: Dexmedetomidine seems to be a better alternative to fentanyl as an epidural adjuvant to local anaesthetics as it decreases pain intensity during post-operative period, delayed time of first analgesic supplementation, provides better sedation level without harmful derangement on hemodynamics.

COMPARISON OF EFFICACY OF EPIDURALLY ADMINISTERED BUTORPHANOL AND TRAMADOL IN PROVIDING POSTOPERATIVE PAIN RELIEF IN ELECTIVE LOWER LIMB SURGERIES - AN OBSERVATIONAL STUDY

BACKGROUND: Using local anaestheticagent as epidural analgesia is simple, effective and economical way of providing postoperative analgesia. Local anaesthetics used epidurally provide good pain relief in the perioperative period. The present study was conduct to assess the safety and efcacy of post-operative analgesia with epidural butorphanol and epidural tramadol and their efcacy been compared. MATERIAL: All adult patients eligible by the mentioned inclusion criteria were considered as sample, and were observed and analyzed for a duration-based study. Present study includes total 78 patients, which were further divided in two equal groups. Group A (39 Patients) received 15ml of 0.5% Bupivacaine with 1 mg of butorphanol (Total volume 16 ml) Group B (39 Patients) received 15ml of 0.5% Bupivacaine with 50 mg of tramadol (Total volume 16 ml). In present study there was no statistically signica RESULTS: nt difference in both in both group with respect to demographically such as age, gender, height, weight and ASA grade. In this study it was found that VAS score increased at 5 hours in butorphanol group whereas in tramadol group increased at 6 hours and there was statistically signicant difference in VAS score from 4 hours to 8 hours postoperatively. There was no statistically signicant difference seen between two groups in mean reductions of heart rate. In this study there was no statistically signicant difference between two groups in mean systolic and mean diastolic blood pressure from baseline till 120 mins. The mean time of onset of sensory block in the study was 12.79±1.43 min in Group A and 13.87±1.43 min in Group – B. It can be CONCLUSION: concluded from this study that epidural bupivacaine with butorphanol provides a rapid but shorter duration of analgesia when compared to epidural bupivacaine with tramadol. Epidural bupivacaine with butorphanol had lesser side effects like nausea, vomiting, pruritus than bupivacaine with tramadol group.

PAIN MANAGEMENT IN POSTOPERATIVE TOTAL KNEE ARTHROPLASTY IN EPIDURAL BUPIVACAINE INJECTION VERSUS INTRA-ARTICULAR INJECTION

Total Knee Arthroplasty (TKA) improves the quality of life of osteoarthritic and rheumatoid arthritis patients, however, is associated with moderate to severe postoperative pain. There are multiple methods of managing postoperative pain that include epidural anesthesia but it prevents early mobilization and results in postoperative hypotension and spinal infection. Controlling local pain pathways through intra-articular administration of analgesics is a novel method and is inexpensive and simple. Hence, we assess the effects of postoperative epidural bupivacaine injection along with intra-articular injection in total knee replacement patients.The methodology included 100 patients undergoing TKA randomly divided into two groups, one administered with only epidural bupivacaine injection and the other with intra-articular cocktail injection. The results were measured based on a 10-point pain assessment scale, knee's range of motion (ROM), and Lysholm knee score.The VAS score was lower in the intra-articular cocktail group compared to the bupivacaine injection group until the end of 1-week post-administration (p&lt;0.01). Among inter-group comparisons, we observed that the range of motion was significantly more in cocktail injection as compared to the bupivacaine group till the end of one week (p&lt;0.05). Lysholm's score was significantly more in cocktail injection as compared to the bupivacaine group till the end of one week (p&lt;0.05).Our study showed that both epidural bupivacaine injection and intra-articular injection were effective in reducing pain after TKA and have a comparable functional outcome at the end of 4 weeks follow up. However, the pain relief was faster in cases with intra-articular injection, providing the opportunity for early rehabilitation. Thus, we recommend the use of intra-articular cocktail injection for postoperative management of pain after total knee arthroplasty, which enables early rehabilitation and faster functional recovery of these patients.

Efficacy of Single-shot Epidural with Bupivacaine and Dexamethasone as an Adjuvant for Postoperative Analgesia in Patients Undergoing Major Abdominal Surgeries

Background: Apart from being distressful, postoperative pain produces a range of harmful effects, including morbidity and mortality. Epidural analgesia is a safe and effective method for the control of postoperative pain. Aim: This study compared the analgesic efficacy of single-shot epidural bupivacaine plus dexamethasone versus single-shot epidural bupivacaine and intravenous (IV) dexamethasone after major elective abdominal surgery. Methodology: A cross-sectional cohort study was conducted on 30 adult patients undergoing major elective abdominal surgery. Fifteen minutes before the reversal of neuromuscular blockade, study Group “A” received an epidural of 0.125% bupivacaine at the dose of 1.0 mL/segment and dexamethasone 8 mg and Group “B” included data of 30 adult patients which was drawn from the well-matched historic cohort, from past anesthesia records, where patients received an epidural of 0.125% bupivacaine at the dose of 1.0 mL/segment, but an injection of dexamethasone 8 mg was administered intravenously. Results: The primary outcome was a significantly longer duration of analgesia (905.97 ± 110.89 min) in Group “A” patients in comparison to Group “B” patients (731.0 ± 112.59 min) (P &lt; 0.0001). The secondary outcome included the requirement of total rescue analgesic dose of injection tramadol, which was significantly lower in Group “A” compared to Group “B” patients (163.90 ± 15.93 mg vs. 182.27 ± 30.61 mg, respectively), (P &lt; 0.005). Postoperative nausea and vomiting incidence was lower in patients of Group “B” due to the antiemetic effect of IV dexamethasone. Conclusion: Single-shot bupivacaine with dexamethasone gives longer postoperative analgesia and lesser rescue analgesic requirement compared to epidural bupivacaine with IV dexamethasone.

A COMPARATIVE STUDY OF DEXMEDETOMIDINE AND MAGNESIUM SULPHATE AS AN ADJUVANT TO BUPIVACAINE FOR POSTOPERATIVE EPIDURAL ANALGESIA IN LOWER LIMB SURGERIES

Background:Pain is pathologic entity,noxious stimulus and a most common problems challenging the anaesthetist.Regional anaesthesia is a safe,inexpensive technique that inhibits the nerve transmission to relieve pain and also provide postoperative analgesia.Magnesium is N-methyl D-aspartate receptor and physiological calcium antagonist.Dexmedetomedine is α2 receptor antagonist with analgesic and sedative properties. Objectives: To compare the duration of postoperative analgesia,time of administration of first rescue analgesia,systemic side effects of epidural bupivacaine with Magnesium sulphate and dexmedetomidine. Methods: After approval of ethical committee and informed written consent A prospective randomised study was conducted with Sixty ASA grade I and II patients aged between 18-60 years undergoing lower limb surgeries were divided into two groups of 30 each .Group BM and Group BD received 10ml of 0.125% bupivacaine with 100mg of 20%MgSo4 and 12.5mcg of dexmedetomidine respectively.Heart rate,mean arterial pressure,VAS score,time for first rescue analgesia were recorded postoperatively.Epidural analgesia was given when VAS score was more than 4. Results:VAS was significantly less in group BM,time for first rescue analgesia was more in group BM compared to group BD without any systemic side effects . Conclusion:Administration of Magnesium sulphate with bupivacaine provides prolonged postoperative analgesia compared with Dexmedetomidine without any systemic side effects.

Comparison of Epidural Bupivacaine and Buprenorphine to Bupivacaine and Butorphanol for Postoperative Analgesia in Lower Limb Orthopedic Surgery.

Postoperative analgesia is of utmost importance in the treatment of patients undergoing surgery. Good postoperative pain management reduces hospital stay and improves early ambulation. This study compared the efficacy of epidural bupivacaine with buprenorphine to butorphanol in lower limb orthopedic surgery. This study was carried out to investigate the onset of analgesia, the extent of analgesia, sedation score, and side effects of butorphanol with bupivacaine versus buprenorphine with bupivacaine. In a clinical trial study, 100 patients who underwent elective orthopedic lower limb surgery were randomly allocated to two groups. A total of 100 patients with American Society of anesthesiologists grades I and II posted for lower limb orthopedic surgery were enrolled in this randomized, double-blind study. The patients were divided into groups A and B. Subarachnoid block was achieved with 3.4 mL of 0.5% bupivacaine. The pain was monitored by the visual analog scale postoperatively. The patients in group A received bupivacaine with buprenorphine, and group B received bupivacaine with butorphanol when they complained of pain in the postoperative period. The onset of analgesia, duration of analgesia, sedation score, and side effects were compared between the two groups. The onset of analgesia was observed earlier in group A than in group B (7.7 ± 1.6 vs. 12.6 ± 1.7 minutes, P < 0.001). The duration of analgesia was longer in group A than in group B (590 ± 40 vs. 480 ± 54 minutes, P < 0.001). Pulse rates and mean arterial pressures were significantly different (P < 0.001). Side effects were common in both groups. Buprenorphine added to bupivacaine provides earlier onset and longer postoperative epidural analgesia than epidural butorphanol with bupivacaine.

EVALUATION OF INTRATHECAL DEXMEDETOMIDINE ADDED TO BUPIVACAINE FOR LABOR ANALGESIA

Background And Aims: The aim of this study was to evaluate the effectiveness of intrathecal dexmedetomidine with bupivacaine for labor analgesia by assessment of onset, duration and quality of analgesia and neonatal outcomes. Method: In this study 40 eligible parturient who received dexmedetomidine 5 g and heavy bupivacaine 0.5% 2.5 mg diluted upto 2.5 cc with sterile NS intrathecally for labor analgesia were selected. The time of onset, duration and quality of analgesia were noted. Maternal parameters pulse rate, systolic blood pressure, motor block and side effects of pruritus, nausea, vomiting, hypotension and headache were recorded. Neonatal outcomes in terms of mode of delivery and APGAR score were noted. If VAS &gt;3, analgesia was supplemented with epidural bupivacaine 0.125% 10 ml during labor. For rescue analgesia, Inj. Tramadol 1 – 2 mg/kg iv was given as per institutional protocol if the patient VAS score was still more than 3 even after second dose of epidural. Result: Mean time for onset of analgesia was 2 minutes (VAS&lt;3). All parturient had VAS &lt; 3 throughout the labor. Mean duration of Labor was 99.4 ± 48.35 min. Total duration of labor ranges from 45 minutes to 210 minutes in our study. Most 92.5% of parturient had maximum motor blockade of grade 1 and it was lasted maximum upto 30 min. Hypotension was observed in two parturient and one parturient had nausea, which responded to conservative management. The mean APGAR score at 1 min was 8.85 ± 0.97 and at 5 min it was 10 (excluding LSCS delivery). Out of 40 total, 30 parturient have graded labor analgesia as excellent and rest have graded as good. Conclusion: Dexmedetomidine (5μg) seems to be a safe and efcacious adjuvant to intrathecal bupivacaine 0.5% (2.5 mg) in women undergoing vaginal delivery. This may be helpful for parturient coming late to the delivery room, seeking rapid onset with good quality of analgesia

Comparative Study of Magnesium Sulphate versus Dexmedetomidine as an Adjuvant to Epidural BupivacaineA Randomised Controlled Trial

Introduction: Neuraxial adjuvants are used to improve or extend analgesia. They have been utilised in several trials to prolong postoperative analgesia along with spinal anaesthesia, but as epidural anaesthesia is more haemodynamically stable, adding adjuvants to the above will have substantially less detrimental effects. Dexmedetomidine and magnesium sulphate may be used as adjuvants in neuraxial anaesthesia along with local anaesthetics. Aim: To determine the impact of adding magnesium and dexmedetomidine in the lower limb and lower abdominal procedures as an adjuvant to epidural bupivacaine. Materials and Methods: This randomised, single blinded study was conducted on 90 ASA (American Society of Anaesthesiologists) class I and II patients in the Department of Anesthesiology Government Medical college, Kannur, Kerela from September 2015 to September 2016. Following randomisation using the lottery approach, the patients were divided into groups M, D, and C, and given the appropriate drugs through the epidural route. Group D: Bupivacaine 0.5% 10 mL+Dexmedetomidine 0.5 mcg/kg (in 1 mL 0.9% saline); group C: Bupivacaine 0.5% 10 mL+Saline 0.9% (1 mL); group M: Bupivacaine 0.5% 10 mL+MgSO4 50 mg (in 1 mL 0.9% saline). Monitoring was done for the onset, duration, haemodynamic parameters, level of motor and sensory block attained and any adverse outcomes. Data were collected, and statistical analysis was done by Statistical Package for Social Science (SPSS) version 17.0 and Analysis of Variance (ANOVA) with repeated measurements and the contingency coefficient test were both used. Results: Group D had greater postoperative analgesia (307.3±77.3 minutes), while the duration for the onset of sensory (13.1±1.3 minutes) and motor blockade was much shorter. Prolonged motor block and sedation, Ramsay sedation score&gt;3 was observed in Group D. Conclusion: The addition of dexmedetomidine to epidural bupivacaine may be beneficial in the context of the prolonged duration of motor and sensory blockade and arousable sedation.

Efficacy of Epidural and Intramuscular Bupivacaine Injection for Patients Undergoing Lumbar Spine Discectomy on Post-operative Pain Assessment by Visual Analogue Score (VAS)

Efficacy of Epidural and Intramuscular Bupivacaine Injection for Patients Undergoing Lumbar Spine Discectomy on Post-operative Pain Assessment by Visual Analogue Score (VAS)