Highest Level Of Sensory Block Research Articles

A Prospective Randomized Controlled Double Blinded Interventional Study to Compare Post Operative Analgesia Using Sequential Intrathecal Injection of Fentanyl at Different Rates with Hyperbaric Bupivacaine in Lower Segment Caesarean Sections

Background: This study compared rapid and slow intrathecal fentanyl injection followed by a slow injection of bupivacaine to estimate the duration of postoperative analgesia in lower-segment caesarean sections (LSCS). Methods: The study was performed on 60 parturient aged 18-35 years undergoing LSCS and was divided equally into two groups. Group A (Normal Sequential) received slow sequential intrathecal injections of fentanyl and hyperbaric bupivacaine and Group B (Rapid Sequential) received a rapid intrathecal injection of fentanyl followed by a slow injection of hyperbaric bupivacaine. We compared the duration of postoperative analgesia, time of onset of sensory and motor block attained, the highest level of sensory block attained, duration of motor block, Visual Analogue Scale (VAS) scores, spinal anaesthesia-related complications and haemodynamic parameters between both the groups. Results: The duration of postoperative analgesia was longer (P < 0.001) in group B (3.22 ± 0.66 hrs) as compared to group A (2.53 ± 0.41 hrs.) The onset of sensory block was faster (P < 0.001) in group B (1.01 ± 0.29 min) as compared to group A (1.32 ± 0.08 min). More patients in group B achieved higher levels of sensory blockade as compared to group A (5 patients in group A and 12 patients ofgroup B achieved a sensory block up to the T2 dermatome). VAS scores and the requirement of rescue analgesia were significantly lower (10 in group B and 19 in group A). Conclusion: Rapid sequential intrathecal injection of fentanyl and hyperbaric bupivacaine provided better anaesthesia and postoperative analgesia than the normal group.

A Comparative Study of Bupivacaine and Bupivacaine with Fentanyl for Subarachnoid Block

Introduction: Subarachnoid block (SAB) is the anesthesia of choice for lower abdominal and lower limb surgeries. The objective of the study was to evaluate and compare the onset, duration, recovery of neural blockade, hemodynamic changes and side effects of bupivacaine alone with fentanyl added to bupivacaine.Materials and methods: This cross sectional comparative study was conducted in Department of Anaesthesia at National Medical College in 82 patients from April 2023 to September 2023 . Patients of either sex as per American Society of Anaesesiologists, Physical Status I-II between age 20- 60 years were randomly allocated to one of two groups of 41 each.Results: This study showed that there was highly significant difference in the highest level of sensory block achieved between mthe two groups (p < 0.001 ) and motor blockade. Most of patients receiving bupivacaine alone (Group B) had achieved T6 dermatomal sensory level block and Bromage score of 4, while patients receiving fentanyl with bupivacaine (Group F) achieved T8 and also Bromage score of 3 respectively. The mean duration for highest sensory level in group F and group B was 7.76 and 9.66 minutes, respectively. The mean duration for 2 segment regression in group F and group B was 95.28 and 67.24 minutes respectively. Hypotension was significantly high in Group B.Conclusion: Fentanyl added to bupivacaine has an earlier onset of action, prolonged sensory analgesia but earlier motor recovery compared to bupivacaine alone but a comparatively lower sensory dermatomal level without complete motor blockade, adequate for surgical procedures.

Effects of intrathecal dexmedetomidine coadministered with hyperbaric bupivacaine in the lower abdominal surgery: Results of a double-blind, randomized, and controlled trial between two different doses

Background: Although various adjuvants have been added to local anesthetic agents to potentiate its effect, dexmedetomidine is a relatively new drug with only a fewer studies. Aims and Objectives: The present study has been conducted to compare the efficacy of intrathecal hyperbaric bupivacaine alone with dexmedetomidine of two different doses as adjuvants in spinal anesthesia for the lower abdominal surgery. Materials and Methods: This was a double-blinded, randomized, and controlled trial. Total 120 patients of American Society of Anesthesiologists physical status I and II, 70 male and 50 female, aged between 20 and 60 years, were randomized into three groups receiving 15 mg 0.5% hyperbaric bupivacaine with normal saline, 4 μg (microgram) dexmedetomidine, and 2 μg dexmedetomidine, respectively, administered intrathecally. Results: There was significant difference among all three groups with regard to the onset of sensory block and time to reach the highest level of sensory block. Time to reach T10 dermatome, time to reach Bromage 3 motor block, the mean regression time to S1 dermatome level, the mean regression time to reach Bromage 0, and time to first requirement of rescue analgesia – all these variables showed significance when 4 μg dexmedetomidine additive group was compared with 2 μg dexmedetomidine additive group and bupivacaine alone group. Conclusion: In our double-blinded, randomized, and controlled trial, 4 μg intrathecal dexmedetomidine coadministered with 0.5% hyperbaric bupivacaine showed superior efficacy. Further, larger trials are needed to confirm our findings.

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

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

Effect of Intravenous Dexmedetomidine on Spinal Anesthesia.

BackgroundSubarachnoid block (SAB) with hyperbaric bupivacaine is routinely administered for abdominal and lower limb surgeries. Various agents have been used intrathecally as adjuvants to local anesthetic to increase efficacy and prolong the duration of SAB, among which opioids and α2 agonists are most commonly used. Intravenously administered dexmedetomidine has also been shown to prolong the duration of sensory and motor blockade obtained with subarachnoid block.MethodsA total of 212 adult patients scheduled to undergo abdominal or lower limb surgeries were enrolled in this prospective, double-blind, randomized study. They were divided into two equal groups to receive either intravenous dexmedetomidine (group D) 1μg/kg loading followed by maintenance at 0.5μg/kg or intravenous normal saline (group C) after 15 mins of subarachnoid block; no other intraoperative sedatives were used. The onset of sensory block and motor block, and the highest level of sensory block attained were assessed. The time taken for sensory regression to L1, Modified Bromage scale 0, and rescue analgesia requirement were assessed.ResultsPatients receiving intravenous dexmedetomidine showed no significant change in terms of onset and level of sensory block (P-0.774) and the onset of motor block (P-0.738). The time taken for sensory regression to L1 was significantly prolonged (P-0.000). Also, the time taken to achieve Modified Bromage scale of 0 and time taken for rescue analgesia was significantly prolonged (P-0.000).ConclusionIntravenous dexmedetomidine prolonged the duration of sensory and motor block, and also appears to provide sedation with easy arousability and analgesia postoperatively while maintaining hemodynamic stability with no significant side effects.

Evaluation of the effect of intravenous dexmedetomidine on characteristics of spinal anaesthesia with hyperbaric bupivacaine

Aims: A study was performed to evaluate the effect of intravenously administered dexmedetomidine just before spinal anaesthesia, on spinal block characteristics, postoperative analgesia, haemodynamics and sedation. Methods: Sixty patients, aged 18 - 50 years of either sex, ASA grade I & II, who were undergoing elective lower abdominal and lower limb surgeries under spinal anaesthesia with hyperbaric bupivacaine, were randomly allocated in to two equal groups of 30 patients each to recieve 20 ml of normal saline intravenously (group A) and intravenous dexmedetomidine 0.5 mcg/kg prepared in normal saline to a total volume of 20 ml (group D) over a 10 min period as a single dose just before spinal anaesthesia. Onset and duration of sensory blocks and motor blocks, highest sensory block level, time to 2 segment regression, duration of analgesia, perioperative haemodynamic parameters, VAS and sedation scores were assessed. Results: Both groups were comparable with regard to demographic data. The onset of sensory and motor block were significantly earlier in group D as compared to group A. Duration of motor block and analgesia were significantly longer in group D as compared to group A. Sedation score were significantly higher in group D. Though HR and NIBP were significantly decreased in group D, however all patients remained haemodynamically stable. Conclusion: Bolus dose of intravenous dexmedetomidine 0.5 µg/ kg administered just before spinal anaesthesia prolongs the duration of sensory – motor block and postoperative analgesia with arousable sedation.

Comparative study on block characteristics between 2-Chloroprocaine and Bupivacaine for lower abdomen and lower limb surgeries under spinal anaesthesia

Spinal anaesthesia is the most convenient anaesthetic technique that offers many advantages over general anaesthesia for certain surgical procedures. The patient will be awake, polypharmacy can be avoided and airway manipulation is not needed in spinal anaesthesia. It reduces intraoperative blood loss especially for major lower limb Orthopaedic surgeries, lesser incidence of thromboembolic events, provides reliable surgical analgesia with good muscle relaxation and adequate analgesia in the early postoperative period. After finding the suitability according to selection criteria patients were selected for the study and briefed about the nature of the study, the interventions used and written informed consent was obtained. Further, descriptive data of the patients like name, age, sex, detailed history, were obtained and recorded on predesigned and pretested proforma. In this present study, thoracic dermatome level 8 was the most commonly achieved level in both the groups. More number of patients achieved thoracic dermatome level 6 block in group C. Hence the results were statistically significant with respect to highest level of sensory block achieved.

Minimum local anesthetic dose of ropivacaine in real-time ultrasound-guided intraspinal anesthesia for lower extremity surgery: a randomized controlled trial.

Despite the many advantages real-time ultrasound-guided lumbar anesthesia has over traditional lumbar anesthesia, it seemingly involves a much higher dose of ropivacaine. This study aimed to determine the minimum local anesthetic dose (MLAD) and the 95% confidence interval of ropivacaine at different concentrations in real-time ultrasound-guided lumbar anesthesia for lower extremity surgery. A total of 60 patients who were consecutively scheduled for selective lower extremity surgery were enrolled. The patients were randomly divided into two groups, which each received different concentrations of ropivacaine at different initial dosages when Dixon's up-and-down sequential method was applied. The high ropivacaine group and the low ropivacaine group received 0.75% and 0.5% ropivacaine, respectively. The patients' baseline characteristics, the MLAD, and the 95% confidence interval were assessed. The highest level of sensory block, time to reach the T10 sensory block, duration for sensory blocks higher than T10, highest plane for sensory block, and onset time and duration for motor block were recorded. Comparisons were also made between the patients' vital signs and adverse reactions. The minimum local anaesthetic dose (MLAD) and 95% confidence interval in the high ropivacaine group and the low ropivacaine group were 17.176 (16.276 to 18.124) and 20.192 (19.256 to 21.174) mg, respectively. Moreover, motor block maintenance was greatly reduced in the 0.5% ropivacaine compared to the 0.75% ropivacaine group (P=0.0309). In real-time ultrasound-guided intraspinal anesthesia for lower extremity surgery, both 0.75% and 0.5% ropivacaine provide satisfactory anesthesia. Our results suggest that shortened motor block duration can hold benefits for patients including earlier mobilization and a quicker rehabilitation process.

What is the optimal dose of intrathecal meperidine in open prostate surgery? A prospective double-blind randomized study.

This study was an analysis of the effect of different dosages of intrathecal meperidine (40 mg, 50 mg, 60 mg, and 70 mg) on hemodynamic parameters, the duration of neural blockade, and the incidence of meperidine-related side effects in patients who underwent an open prostatectomy. Sixty patients who underwent an open prostatectomy with combined spinal-epidural anesthesia were included. The patients were allocated to receive 1 of 4 different dosages of intrathecal meperidine (n=15 for each group): Group I: 40 mg, Group II: 50 mg, Group III: 60 mg, and Group IV: 70 mg. The duration of the block procedure, surgery duration, highest sensory block level, and anesthetic complications were recorded and analyzed. At 20 minutes after the spinal injection, the maximum sensory block level was T6 in Group I and II, and it was T5 in Group III and IV. The mean motor block scores at 20 minutes after the spinal injection were lower in Group I compared with the other groups (p<0.001 for all). The motor block duration was significantly shorter in Group I and II than in Group III and IV (p<0.001 for all). Surgeon satisfaction was greater in Group II, III, and IV compared with Group I (p<0.001 for all). Patient satisfaction was better in Group III and IV compared with Groups I and II (p<0.001 for all). Intrathecal meperidine at a dose of 60 mg exerted a sufficient analgesic effect with minimum side effects in patients undergoing open prostatectomy.

Comparison of two different anesthesia methods for the procedure for prolapse and hemorrhoids in elderly patients with anorectal diseases

Objective To compare the anesthetic effects of subarachnoid anesthesia(SA)and epidural anesthesia(EA)for the procedure for prolapse and hemorrhoids(PPH)in elderly patients with benign anorectal diseases. Methods A retrospective analysis was conducted in 60 patients with benign anorectal diseases admitted to Peking University Third Hospital from March to August 2018 and undergoing PPH.According to anesthesia methods, patients were divided into the SA group and the EA group (n=30 each). The level of sensory block was tested by acupuncture, and the degree of motor block was assessed by revised Bromage score.The anesthesia effect, operation time, blood loss, adverse events and hospitalization time were compared between the two groups. Results The highest level of sensory block was similar between the two groups without significant difference(P>0.05). The median onset time of sensory block was longer in the EA group [270.0 s(interquartile range, 66.3 s)] than in the SA group [25.5 s(interquartile range, 14.3 s)]. The revised Bromage score was lower in the EA group than in the SA group [1.0(interquartile range, 1.0)vs.2.0 (interquartile range, 1.0), Z=6.657, -1.685, both P=0.000]. The risks of hypotension, nausea and vomiting, and urinary retention were lower in the EA group than in the SA group (χ2=6.405, 4.286 and 4.403, P=0.011, 0.038 and 0.044). There were no significant differences in anesthetic effect, operation time, blood loss and hospitalization time between the two groups(all P>0.05). Conclusions EA can provide a perfect anesthesia and analgesic effect for elderly patients receiving PPH, with the advantages of rapid recovery of limb movement and low adverse events.As a substitute for SA, EA is a suitable anesthesia method for promoting the enhanced recovery after surgery(ERAS)in patients with benign anorectal diseases. Key words: Anesthesia and analgesia; Anesthesia, epidural; Hemorrhoids

Comparison of two doses of Dexmedetomidine on hemodynamic parameters of patients undergoing spinal anesthesia

Background: Dexmedetomidine is considered as safe adjuvant as it does not cause depression of the respiratory system. Whether it can be used in the dose of 5 mcg or 10 mcg needs evaluation. Objective of the study was to compare two doses of dexmedetomidine on hemodynamic parameters of patients undergoing spinal anesthesia.Methods: Present study was hospital based follow up study. 80 patients were studied who were of age 18-60 years. These patients were operated using spinal anesthesia. History in detail was taken. They were examined thoroughly and investigated. Informed written consent is taken. Two groups were made. One group with 30 patients received dexmedetomidine 5 mcg. Second group with 50 patients received 10 mcg dexmedetomidine.Results: All baseline parameters were similar in two group patients. Heart rate at various intervals was also similar in two groups patients. Systolic blood pressure at various intervals was also similar in two groups patients. Diastolic blood pressure at various intervals was also similar in two groups patients. Highest level of sensory block was also similar in two groups patients. Patients in 5 mcg group had both the sensory and motor block more compared to patients in 10 mcg group. All other parameters were similar in two group of patients.Conclusions: Dexmedetomidine in doses of 5 mcg and 10 mcg has been found to have similar effect on hemodynamic parameters of the patients. So, it can be used in any of these two doses without affecting the hemodynamic parameters.

Intrathecal ropivacaine vs bupivacaine in endoscopic urological surgeries: a double blind randomized controlled trial

Aims: To compare sensory, motor effects and haemodynamic stability of 2ml intrathecal isobaric ropivacaine (0.75%) with 3ml hyperbaric bupivacaine (0.75%) in patients undergoing endoscopic urological surgery. Study Design: Randomized controlled trial involving 142 patients undergoing transurethral resection of prostate (TURP) and URS (urethroscopy) in a tertiary care hospital, India. Methods and materials: Patients were randomly allocated to, Group 1 (3ml of 0.5% (15mg) hyperbaric bupivacaine) and Group 2 (2ml of 0.75% isobaric ropivacaine(15mg)). Onset and highest level of sensory block, onset and duration of motor block, quality of anaesthesia and muscle relaxation, haemodynamic parameters and adverse effects if any were studied. Statistical analysis used: Unpaired t-test was used to test continuous variables and chi square test/Fisher’s exact test for categorical variables. Results: The mean of highest sensory block, 2 segment regression of sensory block and time for sensory level to regress below T10 was significantly more in group 1 compared to group 2 (P Conclusion: Ropivacaine provides comparable quality of sensory block but has slower onset and significantly shorter duration of motor block compared to hyperbaric bupivacaine.

Comparison between epidural ropivacaine and ropivacaine–clonidine combination for infraumbilical surgeries: A randomized clinical study

Introduction: Lower abdominal and lower limb surgeries may be performed under local, regional (spinal or epidural) or general anaesthesia, but neuraxial blockade is preferred mode of anaesthesia. Major advantage of epidural anaesthesia over spinal anaesthesia is the ability to titrate the extent and duration of anaesthesia. Aims and Objective: The primary outcome of the study was to measure the duration of sensory analgesia. The secondary outcomes were onset of sensory block, onset of motor block, highest level of sensory block, degree of motor block, duration of motor block, and quality of sensory blockage as measured by visual analog scale. Material and Methods: After getting institutional ethical clearance from our institute and proper written consent from each patient a total of 80 patients who underwent infraumbilical surgeries. A total of 80 patients who underwent infraumbilical surgeries were included randomly into two clinical study groups comprising 40 patients in each study group. Epidural anaesthesia was administered with 20ml of Ropivacaine 0.75% (GROUP-R) and 20 ml of epidural Ropivacaine 0.75% and Clonidine 75mcg combination (GROUP-RC). Statistical Analysis: Statistical comparison was made by comparison between groups by applying chi-square test to a contingency table for categorical data and two sample t–test and independent t-test for numerical data. Result: A total of 102 patients were assessed for eligibility, of which 16 patients did not meet the inclusion criteria and 6 patients were excluded during the study period. The groups was comparable with regard to demographic data and incidences of side effects except for the higher incidence of dry mouth in patients of RC group. Onset of analgesia was much shorter in RC group with prolonged duration of analgesia. The incidence of bradycardia and hypotension was more in RC group as compared to R group which was statistically significant. Conclusion: The addition of 75mcg clonidine to isobaric epidural ropivacaine results in longer, complete and effective analgesia with similar block properties and helped to reduce the effective dose of ropivacaine when compared with plain ropivacaine for infraumbilical surgery

Correlation of Symphysiofundal Height and Abdominal Girth with the Incidence of Hypotension in Cesarean Section Under Spinal Anesthesia using Bupivacaine with Fentanyl as Adjuvant: A Clinical Study.

Background and Aims:A decreased lumbosacral subarachnoid space volume is a major factor in cephalad intrathecal spread of local anesthetic in term parturients due to compressive effect of the gravid uterus. The aim of this study was to assess the relationship of symphysiofundal height (SFH) and abdominal girth (AG) with the incidence of hypotension and the highest level of sensory blockade.Settings and Design:This study was a prospective observational study.Materials and Methods:Ninety parturients under the American Society of Anesthesiologists physical status class II within the age range of 20–30 years, weighing between 60 and 65 kg, and height between 150 and 155 cm were studied, and the SFH and AG of all parturients had been measured just before spinal anesthesia. Hyperbaric bupivacaine 9 mg with 12.5 μg intrathecal fentanyl was administered for subarachnoid block. The incidence of hypotension and the highest level of sensory block were assessed.Statistical Analysis:Correlation analysis (Spearman's rank test) was applied to analyze the data, and P < 0.05 was considered to be statistically significant.Results:The incidence of hypotension was higher with increasing SFH (16.9% with SFH of 30–35 cm, 78.37% with SFH of 36–40 cm; correlation coefficient ρ =0.338) and with increasing AG (5.3% with AG between 85 and 89 cm, 35.7% with AG 90–94 cm, 62.8% with AG 95–99 cm; ρ =0.341), and both were statistically significant (P < 0.001). There was a statistically significant correlation between increasing SFH and maximum sensory block achieved (ρ =0.157, P < 0.001). There was increased level of sensory blockade with increased AG but was not statistically significant (ρ =0.011, P = 0.32).Conclusion:In term parturients undergoing cesarean section under spinal anesthesia, the SFH has a significant positive correlation with the incidence of hypotension and ascent of spinal anesthesia. AG also has a positive correlation with the incidence of hypotension but is not significant with the ascent of spinal anesthesia.

Intrathecal Magnesium Sulfate as Analgesic and Anaesthetic Adjunct to Bupivacaine in Patients Undergoing Lower Extremity Orthopaedic Surgery

Background: Subarachnoid block is a popular mode of anesthesia for lower limb surgeries. Studies of Magnesium Sulfate (MgS04 ) as an adjuvant to intrathecal local anaesthetic are limited. The objective was to find out the analgesic and anaesthetic effect of intrathecal MgS04 added to bupivacaine for spinal anaesthesia in patients undergoing lower extremity orthopaedic surgery.Methods: Sixty ASA I or II adult patients undergoing lower extremity orthopaedic surgery were randomly allocated in a double blinded fashion into two groups of thirty each. Group A received 3.0 ml of 0.5% hyperbaric bupivacaine with 0.15 ml of 50% MgSO4. Group B received 3.0 ml of 0.5% hyperbaric bupivacaine with 0.15 ml of NS. Onset of sensory and motor block as well as time to attain highest level of sensory block were recorded. Duration of sensory and motor block along with duration of spinal anaesthesia were also assessed. Any adverse effects were noted and treated.Results: Duration of sensory and motor block along with duration of spinal anaesthesia were prolonged in patients of MgSO4 but were not statistically significant with p-value of 0.33, 0.23 and 0.68 respectively. Onset of anaesthesia, requirement of rescue analgesics, haemodynamic parameters and adverse effects were comparable between two groups.Conclusion: In patients undergoing lower extremity orthopaedic surgery the addition of 75mg of MgSO4 to intrathecal bupivacaine did not prolong the duration of sensory block, spinal anaesthesia nor decreased postoperative analgesic consumption without any additional side effects. Journal of Society of Anesthesiologists of NepalVol. 4, No. 2, 2017, Page: 74-80

Evaluating the efficacy of low-dose hyperbaric levobupivacaine (0.5%) versus hyperbaric bupivacaine (0.5%) along with fentanyl for subarachnoid block in patients undergoing medical termination of pregnancy and sterilization: A prospective, randomized study

Background: Spinal anesthesia using low doses of local anesthetics with opioids is emerging as a useful technique for day care surgeries. Levobupivacaine, a lesser toxic enantiomer of bupivacaine, has now been increasingly used in various gynecological surgeries. However, its use has not been demonstrated in medical termination of pregnancy (MTP) with sterilization (a kind of day care surgery). This study was performed to compare analgesic and anesthetic effectiveness of low-dose hyperbaric 0.5% levobupivacaine and hyperbaric 0.5% bupivacaine in combination with fentanyl in spinal anesthesia in patients undergoing MTP with sterilization. Methods: A comparative, randomized, double-blind study was conducted in 90 patients scheduled to undergo elective MTP with sterilization. Group levobupivacaine (L) (n = 45) received 7.5 mg (1.5 mL) of 0.5% isobaric levobupivacaine + 1 mL of 5% dextrose and fentanyl 25 mcg (0.5 mL), while group bupivacaine (B) (n = 45) received 7.5 mg (1.5 mL) of 0.5% hyperbaric bupivacaine + 1 mL of normal saline and fentanyl 25 mcg (0.5 mL). They were compared with respect to onset and duration of sensory and motor block, time to reach highest sensory level, time to two segments' regression, and total duration of analgesia. Results: Sensory and motor block onset and time to achieve highest level of sensory block were significantly delayed in group L (P

Motor and sensory blocking effect of intrathecal fentanyl versus dexmedetomidine as adjuvants to bupivacaine for cesarean section

Background Intrathecal α2 agonists prolong the duration of action of local anesthetics and reduce the required dose. Dexmedetomidine is an α2 receptor agonist, and its α2/α1 selectivity is eight times higher than that of clonidine. Aim The aim of this study was to determine the effect of adding dexmedetomidine and fentanyl to intrathecal bupivacaine on the onset time and duration and intensity of motor and sensory blocks for cesarean section. Patients and methods The study was carried out on 40 adult female patients who were randomly classified using closed envelope method into two equal groups, with 20 patients in each: group D patients received intrathecally 2.5 ml volume of 10 mg (2 ml) 0.5% hyperbaric bupivacaine and 10 µg dexmedetomidine in 0.5 ml (prepared by diluting 1 ml dexmedetomidine in 5 ml of normal saline), and group F patients received intrathecally 2.5 ml volume of 10 mg (2 ml) 0.5% hyperbaric bupivacaine and 20 µg fentanyl in 0.5 ml (prepared by diluting 2 ml fentanyl in 2.5 ml of normal saline). The aim was to evaluate motor and sensory block. Sensory block assessment: the onset and duration of sensory block was assessed by ice cube method, and time taken from intrathecal injection to the highest level of sensory block and sensory regression to the L1 dermatome were recorded. On achieving T7 sensory blockade level, surgery was allowed. Motor block assessment: onset and degree of motor block was assessed by Bromage scale: 0, no paralysis; 1, inability to raise extended leg; 2, inability to flex the knee; and 3, inability to flex the ankle (complete motor block). Results Sensory and motor block onset times were shorter in group D than in group F. The regression of the sensory block to S1 dermatome and Bromage 0 were longer in group D than group F. The two-dermatome regression time was longer in group D than group F. There was a statistically significant decrease in group F regarding systolic, diastolic, and mean arterial blood pressures and heart rate than group D. There was no statistically significant difference among the two groups regarding arterial oxygen saturation and respiratory rate. Neonatal outcome was normal in all groups. Conclusion Intrathecal dexmedetomidine addition to bupivacaine for spinal anesthesia synergistically increases block duration and shortens sensory and motor block onset time without any significant adverse effects.

Spinal Anesthesia for Transurethral Resection of Prostate: Levobupivacaine with or without Fentanyl

Background: The aim of the present study was to compare the characteristics of spinal blocks produced by low dose levobupivacaine (0.5%) and compare it when combined with fentanyl in transurethral resection of prostate. Methods: With Institutional ethical committee clearance a prospective, randomized, double-blinded study conducted. After obtaining informed written consent a total of 140 patients scheduled for elective TURP were randomly allocated into one of the two groups of 70 patients each. Following a spinal tap, patients in Levobupivacaine Group(L) received 1.5 ml of 0.5% isobaric levobupivacaine and in Levobupivacaine - Fentanyl Group (LF) received 1 ml of 0.5% isobaric levobupivacaine with fentanyl 25 μg (0.5 ml) intrathecally. The characteristics of sensory and motor block, hemodynamic data, side effects, patient and surgeon satisfaction were recorded. Results: There were no significant differences between the two groups for patient demographic, intraoperative hemodynamic parameters, side effects and satisfaction. The highest level of sensory block was T9 in the Group L, and T8 in the Group LF (p = 0.001). Duration of motor block was shorter in Group LF than in Group L (154.76 ± 16.39 minutes in Group L; 136.23 ± 9.06 minutes in Group LF) (p = 0.001). Conclusion: Both regimes are effective, and the addition of fentanyl to levobupivacaine may offers prolong duration of sensory block and postoperative analgesia and the advantage of shorter duration of motor block, thus it may be used as an alternative to pure levobupivacaine solution in spinal anaesthesia, for transurethral resections.

A prospective randomized study for comparison of epidural 0.5% levobupivacaine with 0.5% racemic bupivacaine using fentanyl as common adjuvant in lower limb orthopedic surgeries

Background: Levobupivacaine, an S(-) isomer of bupivacaine, has been shown a lower risk of cardiovascular and central nervous system toxicity than bupivacaine. This study was aimed to compare racemic bupivacaine and levobupivacaine in epidural anesthesia for lower limb orthopedic surgeries using fentanyl as a common adjuvant. Methods and Material: A randomized prospective study was planned on sixty patients of ASA grade I and II who were admitted for elective lower limb orthopedic surgeries under epidural anesthesia. Patients were randomly divided into two Groups, Group B (n=30) received bupivacaine 0.5% (13ml) and fentanyl 100 µg, Group L (n=30) received levobupivacaine 0.5% (13ml) and fentanyl 100 µg. In both the Group’s onset of sensory and motor block, highest level of sensory block, duration of sensory and motor block, degree of motor block and hemodynamic parameters and complications were assessed perioperatively. Results: Mean duration of onset of sensory block was 9.54±1.03 and 9.85±0.97 min for Group B and Group L respectively and onset of motor block for Group B was 19.48±1.58 min and for Group L was 19.01±1.30 min, which were comparable for both Groups (P >0.05). Mean duration of sensory block was 371.33±13.23 min and 366.17±5.83 min in Group B and L respectively and mean duration of motor block was 273.0±11.0 min and 274.9±18.45 min in Group B and L respectively which were comparable in both Groups, (P > 0.05). The degree of motor block assessed by modified bromage scale was higher in Group B than Group L. Hemodynamic changes and complications having no significant differences between two Groups, (P > 0.05). Conclusion: The combination of levobupivacine and fentanyl is equipotent to bupivacaine and fentanyl in epidural anesthesia. Rather it seems to be a better alternative local anesthetic agent in epidural anesthesia for lower limb orthopedic surgeries. Keywords: Bupivacaine, Levobupivacaine, Fentanyl, Epidural, Orthopedic surgeries

Ultrasound guided pectoral nerve blockade versus thoracic spinal blockade for conservative breast surgery in cancer breast: A randomized controlled trial

BackgroundBreast surgery is commonly performed in geriatric patients. In this age group, patients commonly suffer from comorbidities, making regional anesthesia the preferred option during surgery. Both segmental thoracic spinal anesthesia (TSA), thoracic paravertebral (TPB) and pectoral nerve (Pecs) blocks were tried successfully. This encouraged us to compare between segmental thoracic spinal anesthesia (TSA) and pectoral nerve (Pecs) block for surgeries in the thoracic region, namely breast surgery.MethodsForty (ASA) I–II patients aged between 40–65 years with cancer breast surgeries were enrolled in this study. In regard to anesthetic choice, patients were randomly divided into two groups, with 20 patients in each: Group A, with pectoral nerve block and group B, with thoracic spinal block. Standard monitoring in the form of mean blood pressure (MBP) and heart rate (HR) was recorded. Onset time for sensory block, time to reach peak sensory level, regression times of motor blocks and sensory blocks. Intraoperative VAS and post-operative VAS were recorded. Any postoperative complications such as bradycardia, hypotension, nausea and vomiting were assessed.ResultsThe time onset of both sensory and motor blocks was compared; there was statistically significant difference between both groups (P < 0.05). T1 was the highest level of sensory block attained at 17.7 ± 1.7 and 5.5 ± 1.6 min after injection in group A, and group B respectively and the total time for block was significantly prolonged in group A (940.3 ± 17.2 min) compared to group B (315.5 ± 44.3 min) as P ⩽ 0.0001. Regression times of motor blocks and sensory blocks, were significantly prolonged in group A (994 ± 55 min, 940 ± 34 min) compared to group B (382 ± 45 min, 351 ± 35 min) as P < 0.0001.Also, there was significant prolongation of duration of postoperative analgesia with significant reduction of total fentanyl requirement during the first 24 h postoperative in group A compared to group B.Regarding the hemodynamic variables (MBP, HR), there were significant decrease in HR and mean blood pressure (MBP) between the both groups throughout the intraoperative and early postoperative periods.ConclusionIn conclusion, both Pecs and TSB provide effective intraoperative anesthesia and prolonged postoperative pain relief after breast surgery, but the Pecs block is technically simple and easy to learn with few contraindications, provides hemodynamic stability, and has a low complication rate and it is therefore a safe and effective technique in performing intraoperative anesthesia and controlling postoperative pain after unilateral conservative breast surgery.