Highest Level Of Sensory Blockade Research Articles

Comparison of anesthetic efficacy of intrathecal 1% isobaric 2-chloroprocaine with 0.5% isobaric ropivacaine for inguinal hernia surgeries

Background: Inguinal hernia repair is one of the most common surgical conditions. In the absence of other comorbidities, it can be performed as a day-care procedure. Spinal anesthesia is most preferred technique this surgery. Local anesthetics having rapid and smooth onset of action, good intraoperative analgesia, short recovery period, and least side effects are preferred. Aims and Objectives: The objective of the study was to compare the anesthetic efficacy of intrathecal 1% isobaric 2-chloroprocaine (CP) and 0.5% isobaric ropivacaine for inguinal hernia surgeries. Materials and Methods: Sixty patients with ASA grade I/II scheduled for elective inguinal hernia surgeries were randomly allocated into group C (n=30), received 3 mL of 1% isobaric 2- CP and group R (n=30), received 3 mL of 0.5% isobaric ropivacaine intrathecally. Results: Demographic profile, mean time for onset of sensory blockade at T10, highest level of sensory blockade, and maximum motor blockade were comparable among the groups (P>0.05). The highest level of sensory blockade in group C is T7 and group R is T8. The mean time to two segment regression, complete sensory regression, complete motor recovery, recovery of parameters for achieving discharge criteria such as time to unassisted ambulation, drink water, micturition, and first rescue analgesia were significantly shorter in group C (P<0.0001). Visual analog scale score at the time of first rescue analgesia was significantly higher in group C (P<0.0001). Intraoperative hemodynamic changes and perioperative side effects were comparable (P>0.05). Conclusion: CP provides faster block resolution, earlier hospital discharge, and early ambulation with minimal side effects, making it a better alternative to ropivacaine for inguinal hernia surgeries.

Comparative evaluation of intrathecal dexmedetomidine and clonidine as an adjuvant to bupivacaine in gynaecological surgeries

: Spinal anaesthesia is commonly used in gynaecological surgeries, with Bupivacaine being the most commonly used anaesthetic. Bupivacaine, on the other hand, has a shorter duration of action.This clinical study was conducted to evaluate the behaviour of intrathecal clonidine and dexmedetomidine as an adjuvant to bupivacaine in augmenting block characteristics in patients undergoing gynaecological procedures. A randomised controlled trial was conducted to compare intrathecal Dexmedetomidine and Clonidine as adjuvant to Bupivacaine in gynaecological surgeries. A total of 200 patients were divided into 100 groups, each randomly assigned to one of two groups, and intrathecal medication was administered according to the group assigned. The onset and duration of sensory and motor blockade, the highest level of sensory blockade, analgesia duration, and side effects were all evaluated.: Although the time of onset of sensory and motor block in the Dexmedetomidine group was comparable to the Clonidine group, the two-segment regression time was higher in the Dexmedetomidine group as compared to the Clonidine group. The motor block onset according to Bromage grade-3 was 4.1±1.1 minutes and 4.42±1.2 minutes among Dexmedetomidine and Clonidine groups. Throughout the perioperative period, the central tendency values of mean arterial pressures and heart rate remained consistent in both groups. Postoperative analgesia planning and management start from pre-anaesthetic evaluation. So, the analysis revealed that when combined as an intrathecal adjuvant with bupivacaine, dexmedetomidine not only provides better postoperative pain relief than clonidine but also a significantly longer sensory and motor block with preserved hemodynamic stability and lack of sedation.

Comparison of intrathecal Nalbuphine and Clonidine as adjuvants to Bupivacaine heavy for spinal anesthesia in elective infraumbilical surgeries in adult patients – a prospective study

Background: Post-operative analgesia is a major problem associated with relatively short duration of action of spinal-anesthetics. Intrathecal adjuvants can prolong the duration of analgesia giving better success rate & patient satisfaction. Aims and Objectives: To assess the duration of postoperative analgesia with intrathecal bupivacaine supplemented with either nalbuphine or clonidine as adjuvants and also to assess the time of onset, maximum level and duration of sensory and motor blockade, and any postoperative complications. Materials and Methods: Following institutional ethical committee approval 60 patients scheduled for elective infra umbilical surgeries duration of less than 2 hours, under spinal anesthesia, were included in this prospective randomized interventional study. Patients were randomly allocated to one of two groups into Group-N received 2.5 ml of 0.5 % hyperbaric bupivacine + 0.5ml of nalbuphine (0.4mg). Group-C received 2.5 ml of 0.5% hyperbaric bupivacine + 0.5 ml of clonidine (30 μg). The onset of sensory and motor blockade, duration of sensory and motor blockade, two-segment regression time from highest level of sensory blockade, and duration of analgesia was recorded. Results: Total duration of postoperative analgesia was significantly higher in group-C(351.00±31.00 min) than in group-N(256.00±8.14 min). Though the mean time for onset of sensory and motor block among both groups was not significantly different, the mean time for complete sensory and motor recovery was significantly longer in Group-C than Group-N. Conclusion: Intrathecal clonidine has more prolonged analgesia and motor blockade compared to nalbuphine, and hence clonidine can be preferred over nalbuphine as an intrathecal adjuvant.

Comparative study between intravenous dexmedetomidine and clonidine as premedication in pediatric patients undergoing spinal anesthesia

TitleComparative study between intravenous dexmedetomidine and clonidine as premedication in pediatric patients undergoing spinal anesthesia.BackgroundMany techniques and drug regimens, with partial or greater success, have been tried from time to time to eliminate the anxiety component and to prolong the postoperative analgesia during regional anesthesia. In pediatric patients, anxiety and lack of cooperativeness for the regional procedure is the major problem in providing spinal anaesthesia. Alpha2-adrenergic agonists have both analgesic and sedative properties, when used as an adjuvant to regional anesthesia. They eliminate the anxiety, provide conscious sedation, lower the level of agitation and improve patient satisfaction. We designed a prospective, randomized, double-blind study, to evaluate and compare the efficacy of intravenous dexmedetomidine with clonidine as a premedication drug during spinal anaesthesia using intrathecal bupivacaine.Materials and methodsIn this prospective, randomized, double-blind study, 60 pediatric patients 4–10 years of age of the American Society of Anesthesiologists status I, scheduled for uro-genital surgery under spinal anesthesia, were randomly allocated into two groups of 30 each. Group DE received dexmedetomidine 1 μg kg−1 and group CL received clonidine 1 μg kg−1 diluted in 20 ml of normal saline intravenously over 10 min, 40 min before subarachnoid anaesthesia with 0.5% hyperbaric bupivacaine. The patients were monitored every 5 min for 1st 20 min and then every 10 min interval vitals were noted. Acceptable sedation score, parental separation anxiety level and degree of mask acceptance were assessed. Highest level of sensory blockade, time of two segment regression and time of first request of analgesic were also noted. Data was analyzed using Fisher’s exact test or Chi-square test and the value of P < 0.05 was considered statistically significant.ResultsGroup DE and CL had comparable sedation score (p > 0.05). However, parental separation anxiety score and mask acceptance score, were better in DE than CL group (p < 0.05). There was no significant haemodynamic differences between the groups (p > 0.05). Duration of analgesia was also prolonged in DE group.ConclusionDexmedetomidine is superior to clonidine as a premedication drug in pediatric patients undergoing spinal anesthesia.

A Study Of Comparison Of 0.8mg Vs 1.4mg Of Intrathecal Nalbuphine In 3.5ml Of Inj. Bupivacaine Heavy 0.5% In Lower Abdominal And Lower Limb Surgeries

Background: Spinal anaesthesia is a commonly employed technique which provides safe, effective, low cost surgical anesthesia with good post-operative analgesia. Nalbuphine is a semi synthetic opioid with mixed antagonist and k agonist properties. In present study we have compared 0.8mg vs 1.4mg of Intrathecal inj. Nalbuphine with inj. bupivacaine heavy 0.5% 3.5cc to determine the most optimal dose for effective anaesthesia and maximum postoperative analgesia in lower abdominal surgeries. We also observed about the common side effects that occur with opioids like, pruritus, nausea, vomiting, sedation. Material and Methods: Patients were randomly allocated into two groups of 30 participants each. They received either nalbuphine 0.8 mg (group A) or nalbuphine 1.4 mg (group B) diluted upto 0.5ml with normal saline, mixed with 17.5 mg of hyperbaric bupivacaine 0.5% (3.5 ml). The onset of sensory blockade, onset of motor blockage, duration of sensory blockade, two-segment regression time from highest level of sensory blockade and duration of motor blockade were recorded following procedure. Results: In this study, we found that intrathecal injection Nalbuphine combined with intrathecal bupivacaine provides faster onset of sensory and motor blockage along with intraoperative hemodynamic stability. Addition of 1.4 mg intrathecal Nalbuphine in comparison with 0.8 mg provides better postoperative analgesia. The duration of sensory and motor blockade were increased without significantly increasing the incidence of side effects such as sedation, pruritus, nausea/vomiting and respiratory depression. Conclusion: In conclusion, Intrathecal Nalbuphine (1.4mg) added to Intrathecal Bupivacaine 0.5% heavy (17.5mg) provides prolonged postoperative analgesia without increasing risk of side effects. Further studies are required to determine optimal dosage of intrathecal Nalbuphine.

A comparative study of intrathecal clonidine and dexmedetomidine on characteristics of bupivacaine spinal block for lower limb surgeries

Introduction:Intrathecal clonidine or dexmedetomidine has improved the quality of spinal anesthesia, this clinical study was undertaken to assess the behavior of intrathecal clonidine as an adjuvant to bupivacaine in augmenting sensory block in patients undergoing lower limb surgeries.Materials and Methods:We studied 150 patients, between 18 and 60 years of age, patients were randomly divided into three groups of 50 each Group B: 0.5% bupivacaine 15 mg + 0.5 ml normal saline Group C: 0.5% bupivacaine 15 mg + 50 μg clonidine Group D: 0.5% bupivacaine 15 mg + 5 μg dexmedetomidine. Onset and duration of sensory block and motor block, the highest level of sensory blockade, duration of analgesia, and side-effects were assessed.Results:The onset of motor block was faster in Group C and Group D as compared to Group B, The time to reach Bromage scale 3 was fastest in Group C followed by Group D P < 0.001. The duration of sensory, motor blockade and duration of analgesia was longer in Groups C and D as compared to Group B, longest in Group D followed by C and B. The time to regression time to S1 dermatome was. It was longest in Group D followed by Group C and then Group B. Intergroup comparison B to C, B to D and C to D was significant. Duration of analgesia was significantly prolonged in Group C and Group D (P < 0.001) with a mean duration of 309.6 ± 50.99 min in Group C and 336.8 ± 55.38 min in Group D as compared to 204.8 ± 16.81 min in Group B. Intergroup comparison B to C, B to D and Group C to D was significant. Duration was longest in Group D followed by Group C and then Group B.Conclusion:Supplementation of bupivacaine spinal block with a low dose of intrathecal dexmedetomidine (5 μg) or clonidine (50 μg) produces a significantly shorter onset of motor and sensory block and a significantly longer sensory and motor block than bupivacaine alone.

English

BACKGROUND: Anesthesiologist frequently tailors the subarachnoid local anesthetic dosage according to parturient height to achieve sensory blockade up to the T4 dermatome for lower segment Caesarean sections (LSCSs). Studies that have been conducted have demonstrated that height does not affect the spread of subarachnoid hyperbaric bupivacaine. This study aimed to  find the correlation between the spinal column length of term parturient and the highest level of sensory blockade after spinal anesthesia. METHODS: This study is conducted at the Sanjeevan Hospital Neminath Nagar Sangli, Maharashtra India from January 2004 to December 2013 The authors studied 138 term parturient of American Society of Anesthesiologists (ASA) physical status I or II scheduled for elective LSCSs. The length of the spinal column was taken as an average of three measurements from the C7 spinous process to the sacral hiatus in a sitting upright and facing forward position. Spinal anesthesia was given by administering 1.8 ml of 0.5% hyperbaric bupivacaine through the L3/L4 or L4/L5 intervertebral space. The level of sensory blockade was assessed using pin-prick testing for pain sensation. Linear regression analysis was used to analyze the correlation; R <0.25 indicates no correlation with the level of significance being < 0.05. RESULTS: The spinal column lengths measured were between 42.2 cm and 85.8 cm (median: 58.5 cm). Spinal anesthesia given was adequate for all patients, with the highest levels of anesthesia ranging from T8 to T2 with sensory levels between T6 and T4. The parturient spinal column length showed no correlation with the highest level of sensory blockade achieved, namely R = 0.11. CONCLUSIONS: The study found no correlation between the parturient spinal column length and the highest level of sensory blockade achieved.

Intrathecal Bupivacaine in Comparison With a Combination of Nalbuphine and Bupivacaine for Subarachnoid Block

We performed this randomized, prospective double-blind study to evaluate the effects of 2 different doses of intrathecal nalbuphine (a synthetic opioid agonist-antagonist) on the onset, duration of action, side effects, and complication produced by intrathecal hyperbaric 0.5% bupivacaine in lower abdominal, urologic and lower limb surgeries. Seventy-five patients of ASA grades 1 and 2 of either sex in the age group of 20-60 years were randomly allocated to 1 of 3 groups. Group A (n = 25) received 2.5 mL of 0.5% hyperbaric bupivacaine + 1 mL sterile water intrathecally; group B (n = 25) received 2.5 mL of 0.5% hyperbaric bupivacaine + 1 mL (200 μg) nalbuphine intrathecally; group C (n = 25) received 2.5 mL of 0.5% hyperbaric bupivacaine + 1 mL (400 μg) nalbuphine intrathecally. The onsets of sensory and motor blockade, highest level of sensory blockade, 2 segment regression time of sensory blockade, duration of motor blockade and analgesia, visual analog scale score, hemodynamic and respiratory changes, side effects were recorded, tabulated, and analyzed. Onsets of sensory and motor blockade and duration of motor blockade were not affected. Two segment regression time of sensory blockade and duration of analgesia were maximally prolonged in group C (P < 0.05). The visual analog scale scores were in the following order: group A > group B > group C at 90, 120, and 150 minutes after induction (P < 0.05). Hemodynamic and respiratory complications were absent except in 2 patients in groups A and C each, and 1 patient in group B developed bradycardia (P > 0.05). One patient in group A had nausea and vomiting, 2 patients in each group developed shivering (P > 0.05). No other side effect or complication was observed. Nalbuphine hydrochloride (400 μg) significantly prolongs the duration of sensory blockade and postoperative analgesia without any side effect or complication when introduced intrathecally along with hyperbaric bupivacaine.

Correlation between spinal column length and the spread of subarachnoid hyperbaric bupivacaine in the term parturient

AbstractBackground: Anaesthetists frequently tailor the subarachnoid local anaesthetic dosage according to parturient height to achieve sensory blockade up to the T4 dermatome for lower segment Caesarean sections (LSCSs). Studies that have been conducted have demonstrated that height does not affect the spread of subarachnoid hyperbaric bupivacaine. This study aimed to find the correlation between the spinal column length of term parturients and the highest level of sensory blockade after spinal anaesthesia.Methods: The authors studied 60 singleton term parturients of American Society of Anesthesiologists (ASA) physical status I or II scheduled for elective LSCSs. The length of the spinal column was taken as an average of three measurements from the C7 spinous process to the sacral hiatus in a sitting upright and facing forward position. Spinal anaesthesia was given by administering 1.8 ml of 0.5% hyperbaric bupivacaine and 25 μg fentanyl through the L3/L4 or L4/L5 intervertebral space. The level of senso...

Evaluation of maternal and neonatal effects of adding tramadol to lidocaine in epidural anesthesia for cesarean section

Background: Opioid analgesics are commonly added to epidural local anesthetics to improve analgesia during surgery. Objectives: The goal of this study was to evaluate the maternal and neonatal effects of adding different doses of tramadol to 2% lidocaine in the epidural anesthesia for cesarean section. Patients and Methods: Ninety pregnant patients who were candidates for cesarean section under epidural anesthesia were randomly categorized into three groups. Group L received 2% lidocaine. In the LT50 and LT100 groups, 50 and 100 mg of tramadol were added to epidural 2% lidocaine. For additional analgesia during surgery, 2% lidocaine through epidural catheter or IV sufentanil were administered. Analgesia after surgery was provided by IV injection of meperidine. Onset and duration of sensory and motor blockades, total drug consumption, neonatal Apgar score, and complications were recorded. Results: In the LT100 group, onset of complete sensory and motor blockade at T6 was less than in the two other groups, but the highest level of sensory blockade and two segment regression and duration of motor blockades between the LT50 and LT100 groups were not significantly different, although they were higher and more prolonged than in the L group. Average lidocaine and sufentanil consumption during surgery between the LT50 and LT100 groups were not significantly different but were lower than in the L group. The incidence of maternal complications and neonatal Apgar scores were not significantly different between the three groups. In the LT50 and LT100 groups, the time until the first request for analgesics after surgery was prolonged, and average meperidine consumption was less than in the L group. Conclusions: The addition of tramadol to epidural 2% lidocaine offers advantages in cesarean section.

Spinal Anesthesia with Plain Bupivacaine 0.5%

Onset (defined as the time between injection and achievement of the highest level of sensory blockade), duration, and regression of sensory and motor blockade after the intrathecal administration of 3 mL plain bupivacaine 0.5%, previously equilibrated to either 37 degrees C or 20 degrees C, were studied in two groups of 20 patients. In patients receiving the solution equilibrated to 37 degrees C, the maximum level of sensory blockade was significantly higher (T 4.6 vs T 7.5), variability was smaller (SEM 0.33 vs 0.58), and duration of the sensory level of blockade at or above T 6, T 8, and T 10 was significantly longer (56 min vs 20 min, 101 min vs 59 min, and 131 min vs 77 min, respectively). There were no significant differences with regard to onset of sensory and motor blockade or either the time needed both for the sensory level of blockade to regress two segments from its highest level and to the first lumbar segment, or the duration of complete motor blockade of the lower limbs. It is concluded that the intrathecal administration of a bupivacaine solution previously equilibrated to 37 degrees C as compared with a solution injected at room temperature results in a higher, more predictable maximum sensory level of blockade with longer duration at or above T 6, T 8, and T 10.