Group LB Research Articles

Liposomal Bupivacaine Versus Bupivacaine and Dexamethasone Intercostal Nerve Blocks for Robotic Thoracic Surgery: A Randomized Clinical Trial.

Introduction For peripheral nerve blocks, using either the liposomal formulation of bupivacaine or plain bupivacaine with epinephrine and dexamethasone as an adjuvant has been shown to improve postoperative pain scores. In a single-blinded, randomized controlled study of patients undergoing robotic-assisted thoracoscopic surgery, we determined if bupivacaine with epinephrine and dexamethasone was noninferior to liposomal bupivacaine mixed with plain bupivacaine when administered intraoperatively as an intercostal nerve block (INB). Methods A total of 34 patients undergoing robotic-assisted thoracoscopic surgery were randomized to receive one of two injectate mixtures during their intraoperative INB. Group LB was administered 266 mg of 13.3 mg/mL liposomal bupivacaine with 24 mL of 0.5% plain bupivacaine, while Group BD was given 42 mL of 0.5% bupivacaine with epinephrine and 8 mg of dexamethasone. The primary outcomes were mean postoperative numerical pain ratings and mean postoperative opioid analgesic requirements. Secondary outcomes included adjuvant pain medication consumption, hospital length of stay, and total opioid use in oral morphine equivalents. Results Group LB exhibited no significant difference in pain scores (p = 0.437) and opioid analgesic requirement (p = 0.095) within the 72-hour postoperative period when compared to Group BD. The median total postoperative opioid requirement was 90 mg in Group LB, compared to 45 mg in Group BD. There were no significant differences in the use of postoperative adjuvant pain medications (gabapentin, p = 0.833; acetaminophen, p = 0.190; ketorolac, p = 0.699). Hospital length of stay did not differ between the groups. Conclusions INBs with the addition of dexamethasone as an adjuvant to 0.5% bupivacaine with epinephrine provided noninferior postoperative analgesia compared to liposomal bupivacaine mixed with plain 0.5% bupivacaine.

Evaluation of Local Anesthetic Blockade in Cats Undergoing Castration in a High-Quality, High-Volume Spay/Neuter Setting: A Randomized, Blinded, Placebo-Controlled Trial

Sustainable high-quality, high-volume spay/neuter (HQHVSN) clinic operations require optimal efficiency and resource-management, and humane patient care. Locoregional anesthesia is not standard across HQHVSN protocols because evidence that these techniques are safe, efficient, and cost-effective in the HQHVSN environment is lacking. The objective of this study was to compare the analgesic efficacy of local anesthesia to placebo in cats castrated in a HQHVSN setting. Eighty-eight shelter-owned male cats presenting to a HQHVSN clinic in the northeastern US between August 2019 and October 2020 were enrolled in this blinded, randomized, placebo-controlled trial. Inclusion criteria included estimated age ≥6 weeks and ≤8 years, body weight ≥3 pounds, and ASA 1 status. Cats were assigned via simple randomization to receive an intratesticular injection of saline placebo (Group SP; n=32), lidocaine 1mg/kg (Group L; n=34), or a mixture of lidocaine 1mg/kg and bupivacaine 1mg/kg (Group LB; n=22) prior to routine castration. Standard HQHVSN protocols for anesthesia and surgery were followed. Indicators of analgesic efficacy included perioperative heart rates, requirements for additional anesthesia, surgeon satisfaction with anesthetic depth and tissue quality, and postoperative pain scores and incisional complications. Treatment groups did not differ in demographic characteristics or baseline heart rate. Group SP showed a significant elevation in heart rate in response to surgical stimulus compared to Groups L (p=0.006) and LB (p=0.002) and to their baseline heart rate (p<0.001). Perioperative heart rates measured in Groups L and LB did not differ. Surgeon-reported unsatisfactory anesthetic depth during castration occurred more frequently in Group SP (z=2.68; p=0.044). Additional anesthetic requirements, surgeon satisfaction with tissue quality, and postoperative pain and incision scores were statistically similar between groups. Despite the short duration between intratesticular injection to near completion of castration (median [IQR]=5.0 [3.0-7.0] minutes), local anesthesia was effective at decreasing nociception compared to placebo without increasing the frequency of incisional complications. These perioperative benefits support the inclusion of local blocks in multimodal anesthesia/analgesia protocols for HQHVSN clinics. Additional materials and labor costs for administering intratesticular blocks were estimated at $1.07-$1.19 per 4kg cat at the study location.

Equal mixture of 2% lidocaine with adrenaline and 0.5% bupivacaine 20 mL provided faster onset of complete conduction blockade during ultrasound-guided supraclavicular brachial plexus block than 20 mL of 0.5% bupivacaine alone: a randomized double-blinded clinical trial

IntroductionRecent evidence has questioned the advantage of local anesthetic (LA) combinations. This study tested the hypothesis that mixing rapid-onset (lidocaine) and long-duration (bupivacaine) LA would provide faster onset of complete...

Effect of labetalol and lignocaine on hemodynamic response to laryngoscopy and endotracheal intubation

Direct laryngoscopy and endotracheal intubation is a noxious stimuli and induce sympathomimetic responses. Although well tolerated in healthy subjects, it may impose life-threatening arrhythmias, left ventricular failure or rupture of cerebral aneurysm in susceptible patients.
 The aim is to study the effects of intravenous labetalol and lignocaine on haemodynamic responses to laryngoscopy and endotracheal intubation.
 Materials and methods: It is a cross-sectional and randomized controlled study with two study groups was planned. 70 patients were randomly assigned to one of two groups: those receiving Labetalol 0.25 mg/kg (n=35) or those receiving lignocaine 1mg/kg (n=35). The parameters assessed are heart rate, systolic BP, diastolic BP and Mean arterial pressure. Baseline parameters were recorded at the time of induction, post-intubation immediately and 1, 3, 5, 10 minutes later.
 Results: In the current study, at the time of induction, the mean heart rate was 65.97 ± 5.22 per min in group LB whereas the mean heart rate was 76.66 ± 8.49 per min in group LG which was statistically significant (P value <0.001). There was significantly reduced systolic blood pressure at 1min after intubation, 3min after intubation, 5min after intubation, and 10min after intubation in patients of group LB when compared with patients of group LG (P value <0.05). Significantly reduced diastolic blood pressure at 1 min after intubation, 3 min after intubation, 5 min after intubation, and 10 min after intubation in patients of group LB when compared with patients of group LG (P value <0.05).
 Conclusions: It was concluded in the present study that intravenous labetalol of dosage 0.25 mg/kg before laryngoscopy and endotracheal intubation was efficient in attenuating the hemodynamic parameters

The Outcome of Lignocaine HCL, and Labetalol HCL in Low Doses for Attenuation of Hemodynamic Response to Laryngoscopy and Intubation

Background: Recently lower dosages of lignocaine and labetalol have been proven to be beneficial in reducing perioperative adverse cardiovascular events. Objective: In this study our main goal is to evaluate the outcome of lignocaine HCL, and labetalol HCL in low doses for attenuation of hemodynamic response to laryngoscopy and intubation. Method: This prospective study was done at tertiary hospital from January 2020 to December 2021. In this study 100 consenting patients of age group 31–60 years of either sex and various general surgical procedures under endotracheal anesthesia were included in this study. During the study, 100 patients were randomly divided into two groups depending on the study drug to be given: Group LB: Injection labetalol HCL 0.25 mg/kg body weight diluted to 10 ml with 0.9% saline was given IV 5 min before intubation over 60 s, n=50 and Group LG: Injection lignocaine HCL 1 mg/kg body weight diluted to 10 ml with 0.9% saline was given IV 5 min before intubation over 60 s, n=50. Results: during the study, majority were belonged to 41-50 years age group and 60% were male. The increase in mean HR was observed in LG groups but least in labetalol group. Besides that, increase in SBP in group lignocaine but not in labetalol group whereas DBP increased in all both groups almost similarly. RPP in peri-intubation period was most stable in group LB whereas mean atrial pressure increase in group LG was higher than that in group LB. Conclusion: Labetalol was found to be superior for the reduction of HR, SBP, DBP, mean arterial pressure, and RPP during and after laryngoscopy and endotracheal intubation in both intra- and inter-group comparisons.

Efficacy of intrathecal fentanyl versus buprenorphine as an adjuvant to isobaric levobupivacaine in lower limb surgeries

Background: Fentanyl and buprenorphine are the most commonly used adjuvants in spinal anesthesia. There is paucity in literature regarding the comparison of these two adjuvants when used with levobupivacaine. Aim: This study aimed to compare the efficacy and safety of fentanyl and buprenorphine added to isobaric levobupivacaine. Materials and Methods: This prospective randomized double-blind study was undertaken on 60 patients between the ages of 18 and 65 years with the American Society of Anesthesiologists (ASA) physical status 1, 2, and 3 scheduled for lower limb surgery. Group LF (n = 30) received 3-mL isobaric 0.5% levobupivacaine with 10 microgram (mcg) injection fentanyl and Group LB (n = 30) received 3-mL isobaric 0.5% levobupivacaine with 60 mcg injection buprenorphine. Characteristics of sensory and motor blockade, duration of postoperative analgesia, hemodynamic parameters, and adverse effects were recorded. Data were analyzed by appropriate statistical tests and a value of P < 0.05 was considered significant. Results: The onset of sensory block and duration of motor block in both groups were comparable (P > 0.05). The onset of motor block, duration of sensory block, and duration of analgesia were significantly prolonged in Group LB than Group LF (P < 0.05). Six patients in Group LF and three patients in Group LB developed nausea, although the difference was not statistically significant (P = 0.2801). None of the patients in either of the study groups had adverse effects such as bradycardia, hypotension, pruritus, or respiratory depression. Conclusion: Combinations of 0.5% isobaric levobupivacaine (3 mL) with fentanyl (10 mcg) and buprenorphine (60 mcg) show a good safety profile when administered intrathecally, although combination of levobupivacaine–buprenorphine is superior in terms of prolonged sensory block and longer duration of postoperative analgesia.

Comparing General Anesthesia with Preemptive IV Atropine vs General Anesthesia with Single Injection Peribulbar Block with Levobupivacaine 0.5% or Lidocaine 2% for Prevention of Oculocardiac Reflex in Children Undergoing Strabismus Surgery: Randomized Control Study

Abstract Background Strabismus is one of the common health problems among the children. The incidence of the oculocardiac reflex decreases with age and tends to be more pronounced in young, healthy patients, which is clinically significant for pediatric as it is observed with greatest incidence in young healthy neonates and infants undergoing strabismus surgery. Objective to prevent and attenuate the oculocardiac reflex in children age group from (2yrs to 14 yrs) undergoing surgical correction for strabismus. Patients and Methods Three groups were allocated Group C received general anaesthesia combined with pre emptive atropine, Group L received general anaesthesia combined with Peribulbar block with Lidocaine 2 % and Group LB which received general anaesthesia combined with peribulbar block with Levobupivacaine 0.5%. Results In Our study we found that group L which received peribulbar lidocaine 2 % was the most successful group regarding blocking the occurrence of the OCR and with acceptable post operative pain control results. Conclusion In Our study the use of peribulbar block with lidocaine 2 % in combinations with General anaesthesia is very effective against the incidence of OCR in children undergoing strabismus surgery and superior to the Iv pre emptive Atropine with higher surgeon satisfaction while the use of peribulbar levobupivacaine 0.5% combined with general anaesthesia has a great role in post operative pain control with superior patient satisfaction, on the other hand the atropine is a very important emergency drug but our study found that it has a very minor role in both preventing the OCR and post operative pain control in addition to subjecting the patients to the tachycardia and other complications like dryness of the mouth and blushing so its not recommended by our study.

Comparison between Dexmedetomidine and Buprenorphine as Adjuvants to Isobaric Levobupivacaine in Spinal Anaesthesia for Elective Lower Limb Surgeries

Background: Levobupivacaine and racemic bupivacaine are equally effective in spinal anaesthesia with less systemic toxicity seen with levobupivacaine. Buprenorphine and Dexmedetomidine now being evaluated as a potential neuraxial adjuvant. This study has been designed to study various effects and any adverse effects of addition of either dexmedetomidine or buprenorphine to 2 ml of 0.5% isobaric levobupivacaine intrathecally for lower limb surgeries. Methods: In this randomized, double-blind prospective study, 60 patients of ASA I and II were randomized into two groups: group LD and LB (n=30). All patients received a drug volume of 2.5 ml containing 2 ml isobaric levobupivacaine (15 mg). They received dexmedetomidine 10 μg (Group LD) or 60 μg of buprenorphine (Group LB) diluted to 0.5 ml with distilled water added to levobupivacaine in the same syringe. Results: It was found that the onset of sensory block upto T10 and motor block is statistically significantly faster in group LD (109.33 and 153.5, in sec) over group LB (133 and 167.67, in sec). The mean time for two segment regression, the mean time to sensory regression to L1, the mean duration of analgesia and the mean duration of motor blockade is significantly prolonged in Group LD (106.67, 322, 343, 330.5, in min) over Group LB (132.67, 259.67, 290.67, 253.34, in min) with p<0.001. Conclusion: 10μg of dexmedetomidine added to local anaesthetic in subarachnoid block has proved to be a better adjuvant in prolonging the sensory and motor blockade intraoperatively and the duration of postoperative analgesia compared to 60μg of buprenorphine, without significant adverse effects. Keywords: Spinal anaesthesia; Levobupivacaine; Buprenorphine; Dexmedetomidine.

Onset times and duration of analgesic effect of various concentrations of local anesthetic solutions in standardized volume used for brachial plexus blocks

Visualization of the nerve structures of brachial plexus allows anesthesiologists to use a lower dose of local anesthetics. The content of this low dose is not unequivocal, consequently, the pharmacokinetics of local anesthetics used by various authors are difficult to compare. In this study, the onset times and duration of the analgesic effect of local anesthetic mixture solutions used for brachial plexus blocks are investigated and the quality of anesthesia is compared. 85 unpremedicated American Society of Anesthesiologist physical status I-III, 19-83-year-old patients scheduled for upper limb trauma surgery are assigned to four groups for the axillary-supraclavicular block with lidocaine 1% and bupivacaine 0,5% 1:1 mixture (Group LB) or bupivacaine 0.33% (Group BS) or lidocaine 0,66% (Group LS) or bupivacaine 0.5% and lidocaine 1% 2:1 mixture (Group BL). 0.4 ml/kg was administered to the four groups. The onset time was significantly shorter in the lidocaine group (LS 13.0 ± 1.02) than in the other study groups (LB 16.64 ± 0.89; BS 17.21 ± 0.74; BL 16.92 ± 0.51 min ±SEM, p = 0.002). No differences were observed in the onset times between LB, BS, and BL groups (p > 0.05). Statistical differences were found in the duration of local anesthetics between LB (392.9 ± 20.4), BS (546.4 ± 14.9), LS (172.85 ± 7.8), and BL (458.7 ± 11.9 min ±SEM, p = 0.001). Lidocaine does not shorten the onset times, but significantly decreases the duration of action of bupivacaine when used in mixture solutions. Lidocaine exhibits a good quality of block in the applied dose, while other solutions have excellent quality. Bupivacaine without lidocaine has the longest duration of action to achieve the longest postoperative analgesia.

Effect of addition of buprenorphine or dexamethasone to levobupivacaine on postoperative analgesia in ultrasound guided transversus abdominis plane block in patients undergoing unilateral inguinal hernia repair: a prospective randomized double blind controlled trial.

BackgroundThe transversus abdominis plane (TAP) block is an effective technique to block the thoracolumbar nerves innervating the anterolateral abdominal wall. This study was conducted to evaluate the analgesic efficacy and opioid consumption with the use of perineural buprenorphine or dexamethasone in TAP blocks after unilateral inguinal hernioplasties.MethodsThis prospective, randomized, double-blinded, placebo-controlled study enrolled 93 patients scheduled for unilateral inguinal hernioplasty, followed by an ultrasound-guided TAP block. The participants were randomized into 3 groups (31 patients each). Group L received 20 ml 0.25% levobupivacaine + 1 ml normal saline (NS); group LB, 20 ml 0.25% levobupivacaine + 0.3 mg (1 ml) buprenorphine; and group LD, 20 ml 0.25% levobupivacaine + 4 mg (1 ml) dexamethasone. The patients were observed postoperatively for 24 h for first rescue analgesic requirement, total rescue analgesic consumption, and pain scores on the numeric rating scale (NRS).ResultsThe time to first rescue analgesic requirement was significantly longer in Group LB than in groups LD and L (688.87 ± 36.11 min, 601.45 ± 39.85 min, and 383.06 ± 36.21 min, respectively; P < 0.001). The mean total tramadol consumption in the first 24 h was the lowest in group LB (P < 0.001, L vs. LB / LD). Groups LB and LD displayed significantly lower NRS scores than group L (P < 0.001 both).ConclusionsLevobupivacaine with perineural buprenorphine in a TAP block after unilateral open inguinal hernioplasty facilitates prolonged analgesia and reduced requirement for rescue analgesics compared to perineural dexamethasone, without significant side effects.

Comparison of dexmedetomidine v/s buprenorphine as an adjuvant to levobupivacaine in spinal anesthesia for infraumbilical surgeries

Background: There has been a constant research towards the invention of adjuvants to local anesthetics in spinal anesthesia so as to improve the efficacy, minimize the side effects and to provide excellent perioperative analgesia. In this journey, the invention of non-opioid adjuvants to replace the most popular opioid adjuvant has taken a lead role. With this background, in our study we have compared Dexmedetomidine with Buprenorphine as an adjuvant to 0.5% levobupivacaine in spinal anesthesia in patients undergoing infraumbilical surgeries. Methods: Sixty patients randomly allocated to two groups wherein Group LD received 5 mcg of dexmedetomidine with 15mg of 0.5% Levobupivacaine and Group LB received 75 mcg of Buprenorphine with 15 mg of 0.5% Levobupivacaine. Results: There was no significant difference in the onset time of sensory and motor block in group LD and group LB. The duration of sensory and motor block is statistically significantly prolonged in Group LD as compared to Group LB. Degree of Sedation was better in Group LD when compared with Group LB. Hemodyanamic stability was preserved in both the groups. The time for first rescue analgesia was significantly prolonged in Group LD compared to Group LB. Conclusion: Dexmedetomidine as an adjuvant to 0.5% levobupivacaine in spinal anesthesia produces longer duration of sensory and motor block but takes slightly more time to attain complete motor block as compared to Buprenorphine. Dexmedetomidine also provides an additional benefit of providing conscious sedation with fewer side effects.

The effect of different surface pretreatments on the bond strength of veneering resin to polyetheretherketone

The aim of this study was to investigate the effect of different surface pretreatment methods on the bond strength of veneering resin to polyetheretherketone (PEEK) based aesthetic frameworks. Five hundred and forty PEEK disks were fabricated and divided into 6 pretreatment groups (n = 90); (C) untreated control group, (B) airborne-particle abrasion, (S) silica coating, (L) etching with Er:YAG (erbium-doped yttrium aluminium garnet) laser, (LB) etching with Er:YAG laser and airborne-particle abrasion and (LS) etching with Er:YAG laser and silica coating. After topographical surface examinations, specimens were conditioned with adhesive and veneering resin was polymerized onto the PEEK specimens. Twenty-four hours after veneering, specimens were subjected to thermal aging. Afterwards, shear bond strength (SBS) tests were performed and the obtained data were analyzed with one-way ANOVA and Tukey test at a significance level of α = .05. Group B (1.58 ± 0.15 μm), Group L (1.79 ± 0.29 μm), Group LB (2.20 ± 0.23 μm) and Group LS (2.31 ± 0.52 μm) demonstrated significantly higher surface roughness (SR) values compared to Group C (1.03 ± 0.11 μm). Group B (10.97 ± 2.88 MPa), Group S (12.07 ± 2.82 MPa), Group LB (12.09 ± 2.08 MPa) and Group LS (13.14 ± 1.45 MPa) demonstrated significantly higher SBS values compared to Group C (6.35 ± 1.21 MPa). Airborne-particle abrasion, silica coating or their combined use with Er:YAG laser system establish durable bond between PEEK and resin; however, only Er:YAG laser treatment has no positive effect on resin-PEEK bond.

Role of Lignocaine Nebulization as an Adjunct to Airway Blocks for Awake Fiber-Optic Intubation: A Comparative Study.

Context:Airway management is a crucial skill and area of concern for the anesthesiologist. Awake fiber-optic intubation (AFOI) remains the gold standard in managing difficult airway. Anaesthetizing the airway along with psychological assurance is the mainstay for Preparation of AFOI. Different topical and regional techniques have been developed to subdue reflexes and facilitate AFOI.Aim:This randomized controlled study was performed to evaluate the effectiveness of using lignocaine nebulization in addition to specific airway blocks for AFOI.Methodology:This was a comparative study conducted in 60 patients with difficult airway (LEMON score >2) and randomly allocated into two groups of 30 each. Group LB and Group NB received nebulization of 2% lignocaine 4 mL and 0.9% normal saline 4 mL, respectively. Both groups were then given airway blocks as bilateral superior laryngeal (2% lignocaine 1–2 mL each) and transtracheal (2% lignocaine 4 mL) block. Two puffs of 10% lignocaine to nose and postnasal space on each side were given in both groups. Fiber-optic bronchoscopy (FOB)-guided tracheal intubation was Performed. Vital parameters, side effects, bronchoscopy-guided intubation time and other parameters as intubation grading scale, patient comfort score, satisfaction score were recorded. Chi-square test and unpaired t-test were used for statistical analysis.Results:Statistically, no significant differences were found in hemodynamic parameters, demographics, intubation time, and intubation grading scale in both groups. However, overall patient comfort and satisfaction score was better in Group LB.Conclusion:Upper airway blocks provide adequate anesthesia for awake FOB, but when lignocaine nebulization is added to these blocks, it improves the quality of anesthesia and patient satisfaction.

A Comparative Study of Intravenous Esmolol, Labetalol and Lignocaine in Low Doses for Attenuation of Sympathomimetic Responses to Laryngoscopy and Endotracheal Intubation.

Background:Direct layngoscopy and endotracheal intubation is a noxious stimuli and induces sympathomimetic responses. Although well tolerated in healthy subjects, it may impose life threatening arrhythmias, left ventricular failure or rupture of cerebral aneurysm in susceptible patients. Esmolol, Labetalol and Lignocaine attenuate these responses but are associated with side effects of bradycardia, hypotension etc. In lower doses, chances of these side effects are comparatively low. So we designed this prospective clinical trial to assess the efficacy of intravenous esmolol, labetalol and lignocaine in low doses for attenuation of sympathomimetic responses to endotracheal intubation.Materials and Methods:Seventy-five consenting patients of ASA physical status I or II of age range 20 to 60 years, scheduled for different general surgical procedures were randomly assigned to one of the three groups; group ES, group LB and group LG. Participants of group ES, group LB and group LG was given esmolol HCL 0.5 mg/Kg, labetalol HCL 0.25 mg/kg and lignocaine HCL 1 mg/Kg body weight respectively. Outcome variables were HR, SBP, DBP, MAP and RPP. These variables were recorded just after intubation and thereafter at 1,3,5, 7 and 10 minutes of intubation.Results:There was no statistically significant difference regarding the demographic characteristics of the groups. Heart rate and systolic blood pressure was lower throughout the study period in labetalol group. But the values of study parameters were always higher than the baseline in esmolol and lignocaine group. Values of mean arterial pressure was slightly higher in labetalol group but it was much higher in two other groups throughout the study period. Diastolic blood pressure was higher in all the groups. Values of rate pressure product was higher during intubation and at 1minute after intubation in labetalol group but thereafter it was always lower than baseline values.Conclusion:Labetalol 0.25 mg Kg-1 is an effective and safe drug to be used for attenuation of sympathomimetic responses to endotracheal intubation. Esmolol 0.5 mg Kg-1 and lignocaine 1 mg Kg-1 are also effective to some extent and are safe.

Effect of Aquarobic and Weight Training on Cortisol Levels in Obese Women

Exercise is physical stress which potentially causes disruption of homeostasis, especially in sports that is excessively done. Weight Training (LB) and Aquarobic Exercise (LA) can be modulators of handling stress. This research aims at investigating the effect of the difference between LB and LA to physical stress in obese women. The study was conducted in 2014. The method used in this study was randomized experimental pretest-posttest control group design in 36 obese women, aged 45-50 years who were divided into 3 groups, group LB 50% RM, 3 sets, 12 repetition, treatment two times a day for 8 weeks (n = 12), LA 75% HRmax, treatment 2 days for 8 weeks (n = 12) and control group (n = 12). Body Mass Index (BMI) and cortisol levels were measured before and after the treatment. Hypothesis testing was conducted using test (One-Way ANOVA and Kruskal-Wallis) and the mean difference test (Tukey HSD and Mann Whitneys). The results of BMI is increased in the WT group and is decreased in LA group as compared to control group (p &lt;0.05). The decrease of cortisol level is higher than in LA and LB group and controls (p &lt;0.05). LB and LA affect the physical stress that is characterized by the increase in cortisol levels in obese women. Conclusion: LB is more dominant than LA in increasing physical stress.

Femoral and sciatic nerve blockades and incision site infiltration in rabbits undergoing stifle joint arthrotomy

This study was designed to determine whether perineural injections of local anaesthetics decreases intraoperative nociception and improves postoperative analgesia in New Zealand White rabbits undergoing experimental stifle arthrotomy. All animals were anaesthetized using isoflurane and received morphine intramuscularly. The sciatic and femoral nerves of the leg to be operated on were located using a nerve stimulator (1 Hz, 0.5 mA). Rabbits were assigned to a treatment group (LB; n = 12) or a placebo group (P; n = 12) in a randomized blinded fashion. Group LB received lidocaine 2% (1 mg/kg) combined with bupivacaine 0.5% (0.25 mg/kg) injections around the sciatic and femoral nerves (0.1 mL/kg total volume per site) and subcutaneous infiltration of the incision site with lidocaine 1% (1.25 mg/kg). Group P received the same volume of 0.9% NaCl. Rabbits in group P required higher doses of intraoperative fentanyl and propofol to reduce heart rate and suppress increase in systolic blood pressure, and maintain an adequate anaesthetic plane. Interventional analgesia (buprenorphine and carprofen) was required significantly earlier in rabbits in group P (2 and 6 h after the first nerve blockade, respectively) based on assessment of their pain-related behaviour and range of motion. Using a visual analogue scale (0 mm= no pain to 100 mm= maximal possible pain), rabbits in group LB were judged to show significantly less pain compared with rabbits in group P (14 ± 10 mm and 37 ± 25 mm, respectively) 2 h after nerve blockade. In conclusion, this technique of perineural analgesia combined with incision site infiltration reduced intraoperative fentanyl requirements and improved postoperative analgesia in rabbits.

Comparative study of the effect of dexmedetomidine and butorphanol as epidural adjuvants in abdominal hysterectomy under intrathecal levobupivacaine anesthesia

Background: Combined spinal-epidural technique has become increasingly popular in the last few years for abdominal hysterectomies. Opioids or α-2 agonists are being increasingly used as epidural adjuncts. Aims: The aim of this study is to compare the clinical profile of dexmedetomidine and butorphanol when administered epidurally, following intrathecal levobupivacaine (heavy) in combined spinal and epidural anesthesia. Materials and Methods: Sixty adult patients aged 18-60 years, the American Society of Anesthesiologists Physical Status I and II undergoing abdominal hysterectomy were enrolled into the study and randomly divided into two groups: Group LD ( n = 30) received 12.5 mg of 0.5% levobupivacaine (heavy) intrathecally plus dexmedetomidine 1 ΅g/kg in 10 ml saline epidurally and Group LB ( n = 30) received 12.5 mg of 0.5% levobupivacaine (heavy) intrathecally plus butorphanol 10 ΅g/kg in 10 ml saline epidurally. The hemodynamics, block characteristics, and side effects were observed; the data were compiled and analyzed using Student's t -test and Chi-square test. P Results: The demographic profiles of the patients were comparable between the two groups. The onset of sensory analgesia at T10 was significantly faster in the Group LD (92.80 ± 31.51 vs. 105.43 ± 42.04 s). The time to two-segmental regression in dexmedetomidine group was 184.23 ± 45.10 min versus 120.40 ± 33.03 min in butorphanol group ( P P P Conclusions: Dexmedetomidine was a better alternative to butorphanol as an epidural adjuvant providing comparable stable hemodynamics, early onset, and establishment of sensory anesthesia, prolonged postoperative analgesia, and much better sedation.

Infraorbital and infratrochlear nerve blocks combined with general anaesthesia for outpatient rhinoseptoplasty: A prospective randomised, double-blind, placebo-controlled study

IntroductionWe conducted a study to determine the efficacy of bilateral extraoral infraorbital and infratrochlear nerve blocks during outpatient rhinoseptoplasty under general anaesthesia. Patients and methodsIn this prospective, double-blind, randomised, controlled trial, 40 adult patients undergoing outpatient rhinoseptoplasty under general anaesthesia were assigned to receive bilateral infraorbital and infratrochlear nerve blocks with either 10mL of 0.25% levobupivacaine (Group LB) or isotonic saline (control group). Patients in Group LB received 0.1mL/kg of isotonic saline as a placebo and patients in the control group received 0.1mL/kg of morphine. The primary endpoint was total perioperative morphine consumption (intraoperative and in the post-anaesthesia care unit). The secondary endpoints were pain scores, time spent in the post-anaesthesia care unit and the outpatient ward, block-related complications and patient satisfaction. ResultsThe total dose of perioperative morphine was lower in Group LB than in the control group (2.5±2.8mg versus 9.5±3.5mg, respectively, P<0.001). The mean±SD or median [IQR] times spent in the post-anaesthesia care unit (60±10min and 78±33min, respectively, P<0.03) and in the outpatient ward (210 [178–223] min versus 275 [250–300] min, respectively, P<0.001) were lower in Group LB than in the control group. There were no differences between groups for other endpoints. ConclusionBilateral extraoral infraorbital and infratrochlear nerve blocks performed with 0.25% levobupivacaine during general anaesthesia combining remifentanil and desflurane reduce the perioperative dose of morphine and the time spent in the post-anaesthesia care unit and the outpatient ward in adult patients undergoing outpatient rhinoseptoplasty.

Comparison of the Effects of Levobupivacaine with Lidocaine- Epinephrine on Decongestion and Bleeding during Functional Endoscopic Sinus Surgery

Background and Objectives : Bleeding and congestion during functional endoscopic sinus surgery (FESS) can affect directly to the visibility of safe landmarks and surgical outcomes. Levobupivacaine is a long-acting local anesthetic with inherent local vasoconstrictor activity that is effective when administered by local infiltration to the skin. We aimed to compare the use of pre-incision levobupivacaine and lidocaine 2% with epinephrine for intraoperative vasoconstriction and postoperative analgesia in patients undergoing functional endoscopic sinus surgery. Methods : After institutional approval and informed patient consent, fifty six patients were randomly assigned to receive preincisional local infiltration under general anesthesia. Group LB received levobupivacaine 0.25% (n=28) and group LD-E (n=28) received epinephrine plus lidocaine 2%. Decongestion level of the middle turbinate, the occurrence of hemodynamic variability, intraoperative bleeding scores, the quality of the surgical field, and the first rescue analgesic time in 24 h of all patients were recorded. At the 10 th minute, nasal mucosa images were more decongested compared to the images at 5 th minute in levobupivacaine and lidocaine plus epinephrine groups (p=0.00 and p=0.01 respectively). Results : Decongestion level of the middle turbinate, intraoperative bleeding scores, the quality of the surgical field and first rescue analgesic time were similar between the groups (p>0.05). Conclusions : Levobupivacaine may be an alternative to lidocaine plus epinephrine because it provides similar surgical visibility and postoperative analgesia in patients undergoing FESS.

Role of mitochondrial permeability transition pore in lipid emulsion-induced inversion of bupivacaine myocardiotoxicity in rats

Objective To evaluate the effect of mitochondrial permeability transition pore(mPTP)in lipid emulsion-induced inversion of bupivacaine myocardiotoxicity in rats. Methods H9c2 cells were inoculated in 6-well plates at a density of 105 cells/ml, and were randomly divided into 4 groups(6 wells in each group, 2 ml/well)using a random number table: control group(group C), bupivacaine group(group B), lipid emusion+ bupivacaine group(group LB), and lipid emusion+ bupivacaine+ atractyloside group(group LBA). Phosphate buffer solution 100 μl was added to the culture medium in group C. In group B, bupivacaine was added to the culture medium with the final concentration of 1 mmol/L.In group LB, lipid emusion and bupivacaine were added to the culture medium with the final concentrations of 1% and 1 mmol/L, respectively.In group LBA, lipid emusion, bupivacaine and atractyloside(an mPTP opener)were added to the culture medium with the final concentrations of 1%, 1 mmol/L and 30 μmol/L, respectively.All the cells were incubated for 24 h. After the end of incubation, the expression of Bcl-2, Bax, phosphorylated Bad(p-Bad), caspase-3, activated caspase-3, caspase-9, activated caspase-9 and cytochrome c(Cyt c)was detected using Western blot.The expression of Bcl-2 mRNA, Bax mRNA, Bad mRNA, caspase-9 mRNA and Cyt c mRNA was detected using real-time reverse transcriptase polymerase chain reaction.The ratios of Bax/Bcl-2, activated caspase-3/caspase-3, activated caspase-9/caspase-9, and Bax mRNA/Bcl-2 mRNA were calculated. Results Compared with group C, the ratios of Bax/Bcl-2, activated caspase-3/caspase-3, activated caspase-9/caspase-9, and Bax mRNA/Bcl-2 mRNA were significantly increased, the expression of p-Bad was down-regulated, and the expression of Cyt c, Bad mRNA, caspase-9 mRNA and Cyt c mRNA was up-regulated in group B(P 0.05). Compared with group B, the ratios of Bax/Bcl-2, activated caspase-3/caspase-3, activated caspase-9/caspase-9, and Bax mRNA/Bcl-2 mRNA were significantly decreased, the expression of p-Bad was up-regulated, and the expression of Cyt c, Bad mRNA, caspase-9 mRNA and Cyt c mRNA was down-regulated in LB and LBA groups(P<0.05). Compared with group LB, the ratios of Bax/Bcl-2, activated caspase-3/caspase-3, activated caspase-9/caspase-9, and Bax mRNA/Bcl-2 mRNA were significantly increased, the expression of p-Bad was down-regulated, and the expression of Cyt c, Bad mRNA, caspase-9 mRNA and Cyt c mRNA was up-regulated in group LBA(P<0.05). Conclusion The mechanism underlying lipid emulsion-induced inversion of bupivacaine myocardiotoxicity is related to inhibited mPTP opening in rats. Key words: Mitochondrial membrane transport proteins; Fat emulsions, intravenous; Bupivacaine; Drug toxicity; Myocardium