Hyperbaric Bupivacaine For Spinal Anesthesia Research Articles

Comparison of clinical efficacy of hyperbaric ropivacaine with hyperbaric bupivacaine in spinal anesthesia for transurethral resection of prostate: A randomized and double-blind study

Background: Ropivacaine is an ammino-amide local anesthetic agent with properties similar to bupivacaine, but its decreased lipophilicity is associated with reduced incidence of central nervous system toxicity and cardiotoxicity. This study evaluated the safety, efficacy, effects on hemodynamics and complications of spinal anesthesia using 0.5% hyperbaric bupivacaine and 0.75% hyperbaric ropivacaine in patients undergoing transurethral resection of the prostate (TURP). Aims and Objectives: The aim was to evaluate the safety, efficacy, hemodynamic stability, and side effects of spinal anesthesia using 0.5% hyperbaric bupivacaine and 0.75% hyperbaric ropivacaine in patients undergoing TURP. Materials and Methods: Sixty adult patients with physical status classes I and II, as determined by the American Society of Anesthesiologists, scheduled to undergo elective transurethral resection of prostate, were randomly allocated to receive either hyperbaric ropivacaine 0.75% 2.8 mL plus fentanyl 15 mcg or hyperbaric bupivacaine 0.5% 2.8 mL plus fentanyl 15 mcg. The parameters, such as demographic characteristics, duration of surgery, onset of sensory and motor blockade, hemodynamic stability, and complications, were compared in both groups. Results: Hyperbaric ropivacaine exhibited significantly slower onset times for sensory and motor blockade compared to hyperbaric bupivacaine. Patients in the ropivacaine group demonstrated better hemodynamic stability and experienced less hypotension compared to those who received bupivacaine. Moreover, the sensory and motor block lasted significantly longer in the bupivacaine group. Conclusion: About 0.75% hyperbaric ropivacaine is a better choice for spinal anesthesia in elderly patients undergoing TURP as compared to 0.5% hyperbaric bupivacaine.

Intrathecal levo-bupivacaine versus hyperbaric bupivacaine for inguinal hernia repairs in ex-preterm infants: A double blinded randomized prospective study

Intrathecal levo-bupivacaine versus hyperbaric bupivacaine for inguinal hernia repairs in ex-preterm infants: A double blinded randomized prospective study

Effect of intravenous dexamethasone on the duration of hyperbaric bupivacaine spinal anesthesia in lower abdominal surgery, Randomized controlled trial

BackgroundThe purpose of this study was to investigate the effect of intravenous (IV) dexamethasone on the duration of hyperbaric bupivacaine spinal anesthesia.MethodsTwo hundred patients between the ages of 18 and 60, of both sexes with ASA I- II classification scheduled for lower abdominal surgery under spinal anesthesia using hyperbaric bupivacaine 0.5% were randomly divided into two groups: the dexamethasone group (Dexa group) and the control group, with 100 patients in each group. Before the administration of spinal anesthesia, the Dexa group received an intravenous infusion of 8 mg dexamethasone in 500 mL normal saline, while the control group received 500 mL normal saline only. The primary outcome of this study was to assess the effect of IV dexamethasone on the regression of hyperbaric bupivacaine spinal anesthesia. Secondary outcome measures included the total duration of sensory and motor blocks, VAS score, time of first analgesic request, total analgesic consumption within the first 24 h, and the occurrence of any side effects.ResultsThe Dexa group had significantly delayed onset of 2 dermatomes regression (P < 0.001) compared to the control group. Additionally, the Dexa group had significantly longer duration of both sensory block (P = 0.01) and motor block (P < 0.001). The Dexa group had significantly longer duration until the first postoperative analgesic request (P < 0.001) and a lower incidence of side effects compared to the control group.ConclusionAlthough the intravenous administration of dexamethasone had a limited effect on the duration of hyperbaric bupivacaine spinal anesthesia, it improved postoperative VAS scores compared to the control group and decreased overall postoperative analgesic consumption. Therefore, it can be considered a valuable addition to postoperative multimodal analgesia strategies, aiming to minimize total analgesic consumption.Clinical trial registrationID: NCT04778189 (2/3/2021).

IPACK block with spinal anesthesia compared to fentanyl-based spinal anesthesia for postoperative analgesia following arthroscopic meniscectomy: a randomized, prospective study

BackgroundLocal anesthesia and intrathecal narcotics are utilized to provide postoperative analgesia. IPACK (infiltration between the knee capsule and popliteal artery) is a new localized analgesic approach for knee surgery. This randomized study aimed to compare fentanyl-based spinal anesthesia and IPACK block-based spinal anesthesia for postoperative analgesia in patients undergoing arthroscopic meniscectomy.ResultsIn group F, the VAS (visual analog scale) was higher than in group I, whereas the total amount of morphine was lower in group I (P < .05). In group F (3.92 ± 1.54), the initial painkiller request occurred earlier than in group I (8.82 ± 0.44). In addition, total morphine administrated in group F (20.81 ± 0.69) was significantly higher than in group I (9.54 ± 0.73) (P < .05). Group I had a higher level of patient satisfaction 24 h after surgery than group F (P < .05). In the current study, there were no significant adverse effects linked to the use of fentanyl. Moreover, no complications associated with the IPACK block were detected.ConclusionsThe combination of IPACK block and hyperbaric bupivacaine spinal anesthesia is an effective treatment for initial postoperative pain following arthroscopic meniscectomy, according to the findings of this study. IPACK block prolongs postoperative analgesia more than intrathecal fentanyl.Trial registrationThis study was registered with Clinical Trials Registry (NCT05833776).

Hemodynamic and analgesic effect of intrathecal dexmedetomidine with low dose hyperbaric bupivacaine in spinal anaesthesia, caesarean section: a randomized controlled trial

Hemodynamic and analgesic effect of intrathecal dexmedetomidine with low dose hyperbaric bupivacaine in spinal anaesthesia, caesarean section: a randomized controlled trial

COMPARISON OF HYPERBARIC LEVOBUPIVACAINE/ BUPIVACAINE FOR CESEREAN SECTION

Background : Bupivacaine is the most popular local anesthetic agent in obstetric practice Levobupivacaine showed a lower risk of cardiovascular and central nervous system (CNS) toxicity compared to Bupivacaine The aim of this study was to investigate the clinical efficacy of levobupivacaine compared with hyperbaric bupivacaine for spinal anesthesia for cesarean section. Methods: 60 pregnant women in ASA I - II group scheduled to have elective cesarean operation were allocated into the study. Patients were randomly divided into two groups. 10 mg levobupivacaine (0.5%) for Group L (n = 30) patients, 10 mg hyperbaric bupivacaine (0.5%) for B (n = 30) patients were intrathecally administrated a total of 2.0cc. Sensory and motor block characteristics of the groups were assessed with pinprick and Bromage scale observed hemodynamic changes and side effects were recorded. Results: The time to reach maximum dermatome for the sensory block, time to regression by two dermatomes and time to regress to T12 dermatome was found to be significantly long in Group B. It was observed that in Group B, the motor block was faster and lasted longer. Where as hypotension, bradycardia and nausea were less in Group L, the need for ephedrine was higher in Group B (p &lt; 0.05). Conclusion: Since motor block time is shorter, and side effects like hypotension, bradycardia and nausea are less, levobupivacaine can be a good alternative in cesarean sections.

A Comparative Study of Intrathecal Fentanyl and Nalbuphine as an Adjuvant to Hyperbaric Bupivacaine for Spinal Anesthesia in Lower Limb Orthopedic Surgeries: A Prospective, Double-Blind, Randomized Controlled Study.

Spinal anaesthesia is the most commonly used technique for lower limb orthopaedic surgeries as it is economical and easy to administer. Opioids as adjuvants to local anaesthetics during spinal anaesthesia have played a vital role in reducing post-operative pain qualitatively and effectively. This prospective randomised study was conducted on 100 patients divided into two groups scheduled for lower limb orthopaedic surgeries. Group bupivacaine fentanyl (BF) received 25 mcg of fentanyl with 15 mg of bupivacaine and Group bupivacaine nalbuphine (BN) received 1 mg of nalbuphine and 15 mg of 0.5% bupivacaine. The aim of the study was to compare the analgesic efficacy of intrathecal fentanyl and nalbuphine as an adjuvant to hyperbaric bupivacaine for spinal anaesthesia. Duration of effective analgesia, haemodynamic parameters, onset and duration of sensory and motor block, adverse effects, and visual analogue scale (VAS) score were assessed. Duration of effective analgesia was 388±24.88 minutes in the BN group and was higher (p-value <0.001) in comparison to the BF group, which was 304.70±15.76 minutes. Nalbuphine was more effective than fentanyl in providing post-operative analgesia when used as an adjuvant to hyperbaric bupivacaine.

Dexmedetomidine vs. fentanyl as adjuvants to hyperbaric bupivacaine for unilateral spinal anesthesia in lower limb orthopedic surgeries: a randomized trial

Background &amp; Objective: Opioids and α2 adrenergic receptor agonists are commonly used as adjuvants to intrathecal local anesthetics to improve the quality and duration of spinal anesthesia (SA). Fentanyl and dexmedetomidine (DEX) are the most commonly used opioid and α2 agonist respectively. We compared the efficacy of these two when used as adjuvants to hyperbaric bupivacaine for SA for lower limb surgeries.&#x0D; Methods: A total of 54 patients were randomly assigned to receive unilateral spinal anesthesia with bupivacaine 2.5 ml. Group F (n = 27) received 25 μg fentanyl, and Group D received 10 μg DEX added to the spinal bupivacaine. Time to first analgesic request was the primary outcome, while sensory and motor block characteristics, nalbuphine consumption as rescue analgesic, pain scores, side effects and sedation levels were the secondary outcomes.&#x0D; Results: Patients receiving dexmedetomidine as an adjuvant to hyperbaric bupivacaine for spinal anesthesia for lower limb surgeries had a significantly longer time to rescue analgesia than those receiving fentanyl. The mean time to rescue analgesia in Group D was 409.63 ± 74.60 min vs. 295.93 ± 36.72 min (P = 0.000) in the Group F. Also, patients in Group D had significantly longer sensory and motor blocks.&#x0D; Conclusion: Intrathecal dexmedetomidine 10 μg seems to be a good alternative to fentanyl 25 μg when used as an adjuvant in unilateral spinal anesthesia for lower limb orthopedic surgeries with better quality postoperative analgesia and with minimal side effects.&#x0D; Abbreviations: DEX - Dexmedetomidine; NYHA - New York Heart Association; BMI - Body mass index; MBP - Mean blood pressure; SBP- Systolic blood pressure; DBP- Diastolic blood pressure; VAS - Visual Analog Scale&#x0D; Key words: Dexmedetomidine; Fentanyl; Bupivacaine; Anesthesia, Spinal&#x0D; Citation: Ghaly SI, Shafik AM, AlTaher WAMM, Motawashleh MG, Alansary AM. Dexmedetomidine vs. fentanyl as adjuvants to hyperbaric bupivacaine for unilateral spinal anesthesia in lower limb orthopedic surgeries: a randomized trial.      Anaesth. pain intensive care 2023;27(4):456−463. DOI: 10.35975/apic.v27i4.2191&#x0D; Received: March 30, 2023; Reviewed: April 22, 2023; Accepted: April 22, 2023

Comparison of intrathecal dexmedetomidine and intrathecal fentanyl as an adjuvant to bupivacaine during spinal anaesthesia for lower limb orthopedic surgery

Background: In this study, we have compared the addition of fentanyl 25 mcg and dexmedetomidine 5 mcg to 15 mg of 0.5% hyperbaric bupivacaine for spinal anesthesia separately for patient undergoing lower limb orthopedic surgery. Dexmedetomidine is an α-2 adrenoreceptor agonist and it can prolong the motor and sensory block for long spinal anesthesia. It act by binding to presynaptic C-fiber and postsynaptic dorsal horn neurons. The analgesic action is a result of depression of release of C-fiber transmitters and hyperpolarization of postsynaptic dorsal horn neurons. Aims and Objectives: The present study compares the onset, duration of sensory and motor block, postoperative analgesia, hemodynamic changes, and adverse effects of intrathecal dexmedetomidine and intrathecal fentanyl as an adjuvant to bupivacaine during spinal anesthesia for lower limb orthopedic surgery. Materials and Methods: Patient was randomly grouped by close-envelope technique into the three equal group of 30 in each group. Total 90 patients were including in this study. The blind nature of the study was maintained and the study drug is given according as, Group-1: 15 mg of 0.5% hyperbaric bupivacaine. (Control group), Group-2: 15 mg of 0.5% hyperbaric bupivacaine with 25 mcg of fentanyl, and Group-3: 15 mg of 0.5% hyperbaric bupivacaine with 5 mcg dexmedetomidine for spinal anesthesia. Results: Patients in dexmedetomidine Group-3 had a significantly longer sensory (160±18.5 min) and motor block (242±22 min) time as compared to patients in fentanyl and control group (P&lt;0.001). The time to first request of analgesic in the post-operative period was also longer in dexmedetomidine group (245±3.6 min) when compared to bupivacaine and fentanyl in which it was 125±1.0 min and 220±2.5 min, respectively (P&lt;0.001). Conclusion: We concluded that intrathecal dexmedetomidine with bupivacaine for spinal anesthesia is associated with prolong motor and sensory block then fentanyl 25 μg with bupivacaine and bupivacaine alone.

Evaluation of the Effect of Intravenous Dexamethasone on the Duration of Spinal Anaesthesia in Parturients Undergoing Lower Segment Caesarean Section.

Introduction Dexamethasone is shown to prolong the duration of nerve blocks when administered perineurally as well as intravenously. The effect of intravenous dexamethasone on the duration of hyperbaric bupivacaine spinal anesthesia is lesser known. We conducted a randomized control trial to determine the effect of intravenous dexamethasone on the duration of spinal anesthesia in parturients undergoing lower-segment cesarean section (LSCS). Methods Eighty parturients planned for LSCS under spinal anesthesia were randomly allocated to two groups. Patients in group A were administered dexamethasone intravenously, and group B received normal saline intravenously before spinal anesthesia. The primary objective was to determine the effect of intravenous dexamethasone on the duration of sensory and motor block after spinal anesthesia. The secondary objective was to determine the duration of analgesia and complications in both groups. Result The total duration of the sensory and motor blocks in group A was 118.38 ± 19.88 minutes and 95.63 ± 19.91 minutes, respectively. The entire sensory and motor blockade duration in group B was 116.88 ± 13.48 minutes and 97.63 ± 15.15 minutes, respectively. The difference between the groups was found to be statistically insignificant. Conclusion Intravenous 8 mg dexamethasone in patients planned for LSCS under hyperbaric spinal anesthesia does not prolong the sensory or motor block duration compared to placebo.

Comparison of the efficacy of 0.5% isobaric bupivacaine, 0.5% levobupivacaine, and 0.5% hyperbaric bupivacaine for spinal anesthesia in lower limb surgeries

Various advantages of isobaric bupivacaine, levobupivacaine, and hyperbaric bupivacaine are described. There are no studies reliably determining the benefits of these forms of bupivacaine. The purpose of the study was to compare the efficacy of spinal anesthesia (SA) performed with 0.5% isobaric bupivacaine, 0.5% levobupivacaine, and 0.5% hyperbaric bupivacaine. The clinical study was approved by the ethics committee. The sample size was calculated for a confidence level of 99%. 111 patients were randomly allocated into 3 equal groups for spinal anesthesia in lower limb surgeries. In group 1 (1B) spinal anesthesia was performed with 3 ml of 0.5% isobaric bupivacaine (n = 37); in group 2 (2L)—3 ml of 0.5% levobupivacaine (n = 37), in group 3 (3H)—3 ml of 0.5% hyperbaric bupivacaine (n = 37). The criterion for assessing the effectiveness of anesthesia was the need to switch to another type of anesthesia (criterion-no anesthesia), or the need for additional use of narcotic analgesics or local anesthesia during surgery (criterion-reporting of painful feelings during the operation). In 1B anesthesia efficiency by the criterion of additional intraoperative analgesia was 100% (37 patients; 95% CI [0.88–1.0]); 2L—86.4%; (31 patients; 95% CI [0.68–0.92]); 3H—72.9% (27 patients; 95% CI [0.56–0.84]). There were significant differences between groups 1B and 2L: p < 0.05 (p = 0.0104). There were no significant differences between groups 2L and 3H (p = 0.2587). All patients in group 1B developed complete sensory block (++) within 4 (3; 5) min. In group 2L complete sensory block developed in 34 patients (89.4%) within 9 (5; 14) min, in group 3H sensory block developed in all patients within 3 (2.5; 4). The duration of analgesia period between 1B and 2L did not statistically differ (p = 0.73). In 3H the duration of analgesia was 170 (150; 200) min. The study found 83.7% efficacy of levobupivacaine and 72.9% efficacy of hyperbaric bupivacaine in comparison with isobaric bupivacaine (100%) when administered intrathecally in equal volumes and amounts (by the criterion of additional intraoperative analgesia).Trial registration: NCT05184465 (Initial Release: 12/01/2021; date of first publication—11/01/2022).

Intrathecal Buprenorphine versus Intrathecal Fentanyl as Adjuvants to Hyperbaric Bupivacaine in Spinal Anaesthesia for Lower Segment Caesarean Sections: A Randomised Clinical Study

Introduction: Spinal anaesthesia is the choice technique for Lower Segment Caesarean Section (LSCS). When using subarachnoid block (spinal analgesia), opioids are employed as the main adjuvants along with local anaesthetics to achieve intra/postoperative analgesia. These opioids have desirable properties such as reducing the dose of local anaesthetics, minimising side-effects, providing analgesia, and prolonging the duration of anaesthesia. Aim: To evaluate and compare the efficacy between intrathecal Buprenorphine and Fentanyl as adjuvants to hyperbaric bupivacaine (0.5%) in women undergoing LSCS under spinal anaesthesia. Materials and Methods: A randomised double-blinded clinical trial was conducted at Bharati Vidyapeeth Hospital and Research Centre in Pune, Maharashtra, India between July 2021 and February 2022. A total of 80 parturients with American Society of Anaesthesilogists (ASA) grade II, aged 18 and older, scheduled for elective LSCS, were randomly divided into two groups of 40 each. Group B received 1.8 mL of 0.5% Bupivacaine with 60 μg Buprenorphine, while Group F received 1.8 mL of 0.5% Bupivacaine with 25 μg Fentanyl. The onset/duration of motor block and sensory block, intraoperative haemodynamics, sideeffects, postoperative pain, and demand for the first rescue analgesia were assessed using Chi-square test, Fisher’s-exact probability test, or independent sample t-test. Results: Demographic data such as age, weight, Body Mass Index (BMI), and ASA grade were similar in both groups. The mean duration of surgery in Group B and Group F was 48.12±6.86 min and 48.25±6.56 min, respectively. The mean duration of sensory blockade in Group B was 264.38±37.16 min, and in Group F it was 193.50±34.27 min. The total duration of motor block was 231.00±43.74 minutes in Group B and 171.00±36.87 min in Group F. The total duration of sensory and motor block in Group B was significantly longer (p-value &lt;0.05). The mean time to first rescue analgesia in Group B and Group F was 304.63 min and 228.63 min, respectively (p-value &lt;0.05). Conclusion: The present study concluded that both drugs are safe and suitable as adjuvants with local anaesthetics in spinal anaesthesia for LSCS. The addition of intrathecal buprenorphine to bupivacaine provides a more promising postoperative analgesic effect compared to intrathecal fentanyl, without causing any significant maternal or neonatal side-effects.

Effect of Addition of Magnesium Sulphate to Fentanyl and Hyperbaric Bupivacaine in Spinal Anaesthesia for Abdominal Hysterectomy: A Randomised Clinical Study

Introduction: Subarachnoid block is the most acceptable and popular mode of anaesthesia for gynaecological surgeries. Addition of opioids to intrathecal bupivacaine is routinely practised. Magnesium sulphate (MgSo4 ), when used intrathecally has an advantage in preventing central sensitisation to peripheral nociceptive pain because it is an N-Methyl-DAspartate Receptor (NMDA) antagonist. Aim: To find out the efficacy of MgSO4 as intrathecal additive to combination of fentanyl and hyperbaric bupivacaine in prolonging duration of analgesia. Materials and Methods: This randomised clinical study was done between June 2022 to November 2022 in women of American Society of Anaesthesiologists (ASA) grade I and II aged 50 to 70 years scheduled for abdominal hysterectomy under spinal anaesthesia. They were randomly divided into two groups of 30 each (group ‘S’ and group ‘M’). Group ‘S’ received spinal anaesthesia with 3 mL (15 mg) of hyperbaric bupivacaine, 0.5 mL (25 µg) of Fentanyl and 0.1 mL of 0.9% normal saline while group ‘M’ received 3 mL of hyperbaric bupivacaine, 0.5 mL (25 µg) of Fentanyl and 0.1 mL (50 mg) of 50% MgSO4 intrathecally. End points of observation were time for onset of sensory and motor block and duration of analgesia. Data was entered in Microsoft Excel using Statistical Package for Social Sciences (SPSS) version 25.0. Results: Demographic profile was comparable between both the groups. Delay in onset of sensory block was observed in group ‘M’ (9±0.68 minutes) compared to group ‘S’ (4.88±0.47 minutes) (p&lt;0.001). Similarly, onset of motor blockade too was delayed in group ‘M’ (11.92±0.71 minutes) compared to group ‘S’ (6.83±0.65 minutes) (p&lt;0.001). Postoperative analgesia was significantly prolonged in group ‘M’ (262±8.3 minutes) compared to group ‘S’ (235±12.3 minutes) with a p-value of &lt;0.001. Haemodynamic profile and side-effects showed no significant difference between both the groups. Conclusion: Addition of MgSO4 (50 mg) to combination of fentanyl and hyperbaric bupivacaine when given intrathecally prolongs the duration of spinal analgesia significantly in patients undergoing abdominal hysterectomy without significant side-effects.

Intravenous versus intrathecal dexmedetomidine as an additive to hyperbaric bupivacaine in spinal anesthesia for hip arthroplasty. A randomized controlled trial

ABSTRACT Background This study aimed to assess the safety and efficacy of intravenous (IV) versus intrathecal (IT) dexmedetomidine as an additive to hyperbaric bupivacaine in spinal anesthesia in adult patients undergoing hip arthroplasty. Methods This randomized, controlled, triple-blinded trial enrolled 90 patients aged 18–65 years, American Society of Anesthesiologists physical status I–II who were scheduled for hip arthroplasty under spinal anesthesia. The study subjects were randomly assigned into three groups. The control group (group C) received IT hyperbaric bupivacaine (0.5%, 12.5 mg) plus 1 ml of normal saline. The IT group received IT hyperbaric bupivacaine (0.5%, 12.5 mg) plus 5 µg of dexmedetomidine diluted in 1 ml of normal saline. The IV group received hyperbaric bupivacaine (0.5%, 12.5 mg) plus 0.5 µg/kg of dexmedetomidine diluted in 20 ml of normal saline administered slowly IV. A modified Bromage scale was used to assess motor blocks. We used the Numerical Pain rating scale (NRS) for pain assessment. We used morphine for postoperative analgesia. Results Groups IT and IV had significantly lower total morphine consumption and higher time to the first analgesic request than group C. Durations to two-segment regression and motor block regression to Bromage 1 were significantly higher in groups IT and IV than in group C. Motor block regression to Bromage 1 showed a significant difference between the IT and IV groups with a more delayed motor recovery in the IT group. Conclusion Both IV and IT dexmedetomidine extend the effect of the sensorimotor impact of subarachnoid anesthesia, but IT dexmedetomidine was superior to IV dexmedetomidine in adult patients undergoing hip arthroplasty.

COMPARISON OF BUPIVACAINE VERSUS BUPIVACAINE WITH FENTANYL INTRATHECALLY IN CESAREAN SECTION

Objectives: The objectives of the study were to evaluate the efficacy and safety of fentanyl with hyperbaric bupivacaine in spinal anesthesia for caesarean section. Methods: This prospective observational study was conducted in anesthesia department of tertiary care teaching hospital of Gujarat. Group A was given 2.0 ml of 0.5% hyperbaric bupivacaine with 0.25 ml of normal saline and Group B received 2.0 ml of 0.5% hyperbaric bupivacaine with 0.25 ml of injection fentanyl (12.5 μg). Characteristics of sensory blockade, motor blockade, analgesia, APGAR score, surgical variables, hemodynamic parameters, and complications were noted and compared in both the groups. Results: There was no significant difference in onset of sensory block in both groups (p&gt;0.05) but there was statistically significant difference present regarding duration of regression of sensory blockade (p&lt;0.05). Time of motor onset and time to get Grade 0 from Grade 3 block were comparable in both groups (p&gt;0.05). Duration of complete analgesia and duration of effective analgesia were significantly prolonged in Group B as compared to Group A (p&lt;0.001). There was also no statistically significant difference observed in mean pulse rate, systolic blood pressure and diastolic blood pressure, and mean arterial pressure in both the groups during entire period of time (p&gt;0.05). Conclusions: The present study concluded that intrathecal fentanyl 12.5 μg with bupivacaine produce prolonged sensory block as well as post-operative analgesia compared to bupivacaine alone for cesarean section with insignificant hemodynamic changes without affecting neonatal outcome.

Hyperbaric Bupivacaine for Spinal Anaesthesia in Adults Patients: Comparison of Isobaric Bupivacaine 0.5% in 80mg/Ml and 40 Mg/Ml Glucose Solutions

Background: The Baricity of bupivacaine is one of the most important factors to influence the characteristics of distribution of the local anaesthetic and spread of the blockade. Bupivacaine is rendered hyperbaric by adding glucose. The effect of differing degrees of hyperbaricity remains to be evaluated in term of spinal anesthesia blockade. Methods: Hundred patients who underwent lower abdominal, hips, and lower extremity surgeries were randomized into two groups in a double-blind, randomised, parallel group, prospective study. Group I received 0.5% isobaric bupivacaine with 80 mg/ml of glucose, while Group II received 0.5% isobaric bupivacaine with 40 mg/ml of glucose. Injection was made intrathecally in midline position at L3-4 and L4-L5 interspace in sitting position. The measured sensory blockade and motor blockade are the onset and duration. Duration of sensory block was the time measured from the time of the highest block for the regression to the S2 dermatome. Results: Success rate, spread and duration of sensory block were similar in both groups. The highest median level of sensory block was T3 (T2-T7) (median (10th/90th percentiles)) in both groups. Time to reach T10 did not differ between the groups. Power analysis suggested that a total number of 100 adults were required in both groups for a 90% chance at the 0.05 level of significance of detecting a10% difference in success between groups. Categorical data were tested using the chi square test. For continuous data the Mann–Whitney test was used. Results are presented as median (10–90th percentiles), number (%) of cases, the significance was set as P&lt;0.05. Conclusion: These results demonstrate that bupivacaine in 80mg/ml glucose provides reliable spinal anaesthesia of shorter duration and with less hypotension than bupivacaine in 40 mg/ml glucose. The recovery profile for ropivacaine may be of interest given that more surgery is being performed in the day-case setting.

Hyperbaric Prilocaine Versus Hyperbaric Bupivacaine for Spinal Anesthesia in Women Undergoing Elective Cesarean Section: A Comparative Rrandomized Double-blind Study

(Anaesthesia. 2021;76:777–784. [Epub January 11, 2021]) Spinal anesthesia is the standard technique for patients undergoing cesarean delivery (CD). Bupivacaine has been a mainstay for spinal anesthesia for decades due to its minimal onset time and extended duration of motor and sensory block. There are disadvantages, however, such as some effect variability between patients. Prilocaine is a newer local anesthetic and is expected to provide a shorter duration of motor block. The aim of this study is to compare the motor block durations of hyperbaric prilocaine and bupivacaine when used for spinal anesthesia in patients undergoing elective CD.

EFFICACY OF NEOSTIGMINE METHYLSULFATE AND MAGNESIUM SULFATE AS ADDITIVES TO HYPERBARIC BUPIVACAINE FOR SPINAL ANAESTHESIA: A CLINICAL COMPARATIVE STUDY

Background: Intrathecal neostigmine and magnesium sulfate (MgSO4) produce substantial antinociception, potentiate analgesia of bupivacaine without neurotoxicity. The aim of the study was to investigate the effect of neostigmineAims: and MgSO4 on characteristics of spinal anesthesia (SA), hemodynamic stability and postoperative analgesia when added to 0.5% hyperbaric bupivacaine for SA. In this prospective, randomized, single-blindSubjects and Methods: study 90 American Society of Anesthesiologist status I and II adult males and females posted for major lower abdominal surgery were assigned to one of the three groups (n = 25). Group N received Neostigmine 50

Comparison of clinical effects of meperidine and sufentanil added to 0.5% hyperbaric bupivacaine for spinal anesthesia in patients undergoing cesarean delivery: a randomized controlled trial.

The objective of this study was to compare the effect of adding meperidine or sufentanil to hyperbaric bupivacaine in patients undergoing elective cesarean delivery (CD) under spinal anesthesia. The primary outcome was the first analgesic request time, and secondary outcomes included an analgesic requirement in the first 24h and intraoperative and postoperative side effects. This was a randomized, double-blind clinical trial in which patients were allocated into two groups. One group received preservative-free meperidine 12.5mg (1mL) in addition to 0.5% 10mg (2mL) of hyperbaric bupivacaine for spinal anesthesia. The other group received sufentanil 5μg (1mL) added to 0.5% 10mg (2mL) of hyperbaric bupivacaine. A total of 60 parturients were included in the study, 30 patients in each group. Time to first analgesic request was significantly longer in the meperidine group (400.0 ± 142.1min) compared to (274.0 ± 104.1min) in the sufentanil group (P < 0.0001). Around 73% of the parturients in the sufentanil group required analgesics at 4h compared to 13% in the meperidine group (P < 0.0001). There were no significant differences in postoperative pruritus, nausea and vomiting, in addition to shivering. As for surgeon satisfaction, 56.7% reported excellent abdominal muscle relaxation during the surgery in the meperidine group compared to 10% in the sufentanil group (P < 0.0001). Meperidine was superior to sufentanil in terms of improved analgesia, intraoperative postoperative pruritus, and shivering, as well as increased surgeon satisfaction in women undergoing spinal anesthesia for elective cesarean delivery. ClinicalTrials.gov (NCT04446715).

Comparative Study of the Effect of Clonidine and Butorphanol as Adjuvant to Intrathecal Bupivacaine for Post Operative Analgesia in Lower Abdominal and Lower Limb Surgeries

Background: Intrathecal adjuvants to local anesthetic enhance the quality and duration of spinal anaesthesia. The present study was aimed to comparatively evaluate clonidine and butorphanol as adjuvants to intrathecal hyperbaric bupivacaine for subarachnoid blockade during lower abdominal and lower limb surgeries. Patients and Method: Sixty adult consented patients, undergoing elective lower-abdominal and lower-limb surgeries under subarachnoid blockade, were inducted in a blind randomized prospective study conducted in the Department of Anesthesia, GMC Jammu and allocated into 2 equal groups to receive either 3.2 ml of 0.5% hyperbaric bupivacaine (16mg) with 0.2 ml of Clonidine 30 µgm (Group I) or with 0.2 ml of Butorphanol 200 µgm (Group II). Patients were compared for the onset and duration of sensory and motor blockade, intraoperative hemodynamic changes, time to first rescue analgesia, etc. Result: The mean onset time of sensory block was 3.18±0.56 min in Group I and 3.69±0.83 min in Group II. Complete motor block was achieved in 11.53±3.05 min in Group I and in 12.72±3.17 min in Group II, with no significant difference. (p = 0.138) The duration of motor block was 294.28±33.85 min in Group I, as compared to patients of butorphanol group 245.71±30.92 min,(p = 0.046). The need for rescue analgesia was significantly earlier in Group II, ie at 211.09±20.74 min, while at 256.32±24.40 min in group I. Conclusion: Clonidine and butorphanol are good adjuvants to hyperbaric bupivacaine for spinal anaesthesia. Clonidine provides longer duration of sensory and motor blockade and prolonged duration of postoperative analgesia compared to butorphanol. Keywords: Spinal Anesthesia, Clonidine, Butorphanol, Intrathecal Adjuvants, Subarachnoid Blockage.