Hyperbaric Bupivacaine For Spinal Anesthesia Research Articles

The role of granisetron in the enhancement of recovery and home discharge in ambulatory surgery performed under spinal anesthesia

Background The popularity of day-care surgery has increased worldwide due to reduced costs and remarkable safety profile. Neuraxial anesthesia is a popular technique for day-case surgeries. Anesthetist should modify his/her techniques to optimize patient’s chance of early discharge. 5-Hydroxytryptamine type 3 receptor antagonists used to prevent and treat postoperative nausea and vomiting may affect the course of spinal anesthesia and prevent its associated hypotension. Aim The aim of this study was to evaluate the effects of granisetron in the reversal of hyperbaric bupivacaine spinal anesthesia and enhancement of home discharge in day surgeries. Patients and methods Sixty adult patients scheduled for elective day surgery under spinal anesthesia were randomly divided into two equal groups to receive either 1 mg of granisetron (the G group) intravenously diluted in 5 ml normal saline over 30 s, 5 min before spinal anesthesia, or an equal volume of intravenous normal saline (the S group) at the same time. Heart rate, mean arterial pressure, oxygen saturation, and sensory and motor block levels were monitored and recorded. Results Time to regression of sensory level by two dermatomes, time to regression of sensory level to S2, time to first void, and time to discharge readiness were significantly lower in group G. Moreover, the incidence of nausea and shivering was significantly lower in group G. Conclusion Administration of 1 mg of granisetron before spinal anesthesia in ambulatory surgeries resulted in a statistically faster sensory regression and earlier home discharge from the day-surgery unit.

Effect of Two Different Doses of Dexmedetomidine as Adjuvant in Bupivacaine Induced Subarachnoid Block for Elective Abdominal Hysterectomy Operations: A Prospective, Double-blind, Randomized Controlled Study.

Improvements in perioperative pain management for lower abdominal operations has been shown to reduce morbidity, induce early ambulation, and improve patients' long-term outcomes. Dexmedetomidine, a selective alpha-2 agonist, has recently been used intrathecally as adjuvant to spinal anesthesia to prolong its efficacy. We compared two different doses of dexmedetomidine added to hyperbaric bupivacaine for spinal anesthesia. The primary endpoints were the onset and duration of sensory and motor block, and duration of analgesia. . A total of 100 patients, aged 35-60 years old, assigned to have elective abdominal hysterectomy under spinal anesthesia were divided into two equally sized groups (D5 and D10) in a randomized, double-blind fashion. The D5 group was intrathecally administered 3ml 0.5% hyperbaric bupivacaine with 5µg dexmedetomidine in 0.5ml of normal saline and the D10 group 3ml 0.5% bupivacaine with 10µg dexmedetomidine in 0.5ml of normal saline. For each patient, sensory and motor block onset times, block durations, time to first analgesic use, total analgesic need, postoperative visual analogue scale (VAS) scores, hemodynamics, and side effects were recorded. . Although both groups had a similar demographic profile, sensory and motor block in the D10 group (p<0.050) was earlier than the D5 group. Sensory and motor block duration and time to first analgesic use were significantly longer and the need for rescue analgesics was lower in the D10 group than the D5 group. The 24-hour VAS score was significantly lower in the D10 group (p<0.050). Intergroup hemodynamics were comparable (p>0.050) without any appreciable side effects. . Spinal dexmedetomidine increases the sensory and motor block duration and time to first analgesic use, and decreases analgesic consumption in a dose-dependent manner.

Comparative evaluation of hyperbaric ropivacaine with hyperbaric bupivacaine for spinal anesthesia in elective gynecological surgeries

Background Hyperbaric ropivacaine provides adequate sensory and motor block for short duration surgical procedures, safe hemodynamic profile, rapid recovery, early ambulation, and less side effects. Aim and objective The aim of this study was to evaluate the clinical efficacy and safety of subarachnoid block with 0.5% hyperbaric ropivacaine compared with 0.5% hyperbaric bupivacaine in elective gynecological surgeries. Methods Fifty female patients of ASA physical status I and II were randomly selected and divided into two groups: group R and group B. Group R was given 3 ml of 0.5% hyperbaric ropivacaine (15 mg) and group B was given 3 ml of 0.5% hyperbaric bupivacaine (15 mg) during subarachnoid block. Preoperative and intraoperative hemodynamic variables such as heart rate, blood pressure, and SpO 2 were recorded. Sensory and motor block were also assessed at regular intervals. Results The mean time to achieve the highest level of sensory block was 13.1 min in group R and 12.2 min in group B ( P P P P Conclusion Hyperbaric ropivacaine has lower level of cephalad spread of sensory block, takes more time for maximum spread of analgesia, has early regression of sensory block to L5, has longer onset time for motor block, shorter duration of motor block, and causes less hypotension and other side effects compared with hyperbaric bupivacaine.

A comparative study between levobupivacaine and hyperbaric bupivacaine in spinal anesthesia for ambulatory brachytherapy for carcinoma of the cervix

Objective This study aimed to assess the clinical efficacy of levobupivacaine in spinal anesthesia for day-case brachytherapy for carcinoma of the cervix. Study design A prospective, randomized, double-blind study was conducted at the Anesthesia Department of Al-Azhar University Hospitals over a period of 6 months. Patients and methods Between July 2013 and January 2014, 40 female patients were included in the study after approval of the Local Ethics Committee of Anesthesia and Intensive Care Department of Al-Azhar University. Informed consent was taken from the patients who were randomized into two groups. Bupivacaine group, which included 20 patients who received intrathecal 7.5 mg of 0.5% hyperbaric bupivacaine; and levobupivacaine group, which included 20 patients who received intrathecal 7.5 mg of 0.5% levobupivacaine. About 25 mg fentanyl was added to the local anesthetic solution in both groups through the L3/L4 interspace. The upper level of sensory blockade, two-segment sensory regression, S2 regression, side effects of the local anesthetic used, urination, ambulation, and the duration of hospital stay were assessed. Results There were no significant differences between both groups regarding the level of sensory blockade, the onset of sensory blockade to the T10 dermatome, and side effects of the local anesthetic. The time to two-segment regression, S2 regression, ambulation, and the duration of hospital stay were significantly shorter in the levobupivacaine group ( P Conclusion The mixture of 7.5 mg of 0.5% levobupivacaine+25 mg fentanyl given intrathecally was more effective as it provided sensory and surgical blockade with minimal side effects and early home discharge in ambulatory brachytherapy for carcinoma of the cervix compared with 7.5 mg of 0.5% hyperbaric bupivacaine+25 mg fentanyl.

Comparative Study of two Doses of Intrathecal Dexmedetomidine Versus Fentanyl as Adjuvant to Hyperbaric Bupivacaine Spinal Anesthesia

Abstract The aim of this study was to evaluate the effect of addition two different doses of dexmedetomidine or fentanyl to intrathecal hyperbaric bupivacaine on spinal block characteristics, intraoperative hemodynamics, the blood glucose level and postoperative pain. 100 patients ASA I and II, ages 20 -60 years old undergoing elective surgeries below the umbilicus under spinal anesthesia were divided into four groups (n=25 each): Patients were randomly allocated into four equal groups (n= 25, each): Group I: received 3 mL of 0.5% hyperbaric bupivacaine +0.5ml normal saline. Group II: received 3 mL of 0.5% hyperbaric bupivacaine plus 3 μg dexmedetomidine (diluted in 0.5ml of normal saline) intrathecal. Group III: received 3 mL of 0.5% hyperbaric bupivacaine plus 5 μg dexmedetomidine (diluted in 0.5ml of normal saline) intrathecal. Group IV: received 3 mL of 0.5% hyperbaric bupivacaine plus 25 μg fentanyl (0.5ml) intrathecal. intraoperative heart rate and mean arterial blood pressure showed no statistical significant differences between the study groups, patients in group II, III and IV had significantly longer sensory and motor block times than patients in group I. The time of first request of postoperative analgesia was statistically significantly shorter in group I compared to the other groups. Pain scores were higher in group I compared to the other groups. Postoperative blood glucose level was only statistically significantly higher in group II compared to the other groups. Both intrathecal dexmedetomidine and fentanyl are associated with prolongation of sensory and motor block, with stable hemodynamics, minimal effect on blood glucose level, and better postoperative analgesia, compared to intrathecal bupivacaine alone. Key Words: Spinal anesthesia, bupivacaine, dexmedetomidine, fentanyl

Effect of intravenous dexmedetomidine on bupivacaine spinal analgesia

Background: Dexmedetomidine, a new α2 agonist, has been proven to prolong spinal anesthesia when administered through intrathecal route. This study was conducted to evaluate the effects of intravenous (IV) dexmedetomidine on spinal bupivacaine anesthesia. Materials and Methods: A prospective, randomized, double-blind, and placebo-controlled study was conducted on 80 female patients with the American Society of Anesthesiologists (ASA) grades I and II, aged 18-65 years undergoing abdominal hysterectomy under spinal anesthesia. After spinal anesthesia, patients in group D received a loading dose of 1 μg/kg IV dexmedetomidine over 10 min and followed by a dose of 0.2 μg/kg/h till the end of operative procedure, while patients in group C received the same calculated volume of normal saline. The time to reach peak sensory block level, time taken for two segment regression and maximum motor block, Ramsay sedation score, modified Bromage score, and visual analogue scale were recorded and were statistically analyzed using Statistical Package for Social Sciences (SPSS Inc. Chicago, IL, USA) Windows-based version 16.0. Results: Sensory regression to S1 was prolonged in the dexmedetomidine group compared to the control group (294 ± 18.2 min vs. 288 ± 24.3 min, P < 0.05). The time taken for motor block regression to modified Bromage score 6 in groups D and C were 263.73± 38.4 min and 251.7529.6 min, respectively (P = 0.008). Conclusion: IV infusion of dexmedetomidine significantly prolonged the duration of sensory and motor block of hyperbaric spinal bupivacaine with significant side effects.

The minimal effective dose of spinal hyperbaric bupivacaine for successful reliable saddle block for minor perianal surgeries

Objective The aim of this study was to determine the minimal effective dose of spinal hyperbaric bupivacaine required to induce a reliable and satisfactory saddle block for perianal surgeries (using a modified Dixon's up-and-down method). Materials and methods A total of 24 adult patients scheduled for perianal surgeries were enrolled in this study. Dural puncture was performed using a standard midline approach in the sitting position at the L3-L4 intervertebral space, using a 25 G Whitacre needle with its orifice directed caudal. A small quantity (1.5 mg) of hyperbaric bupivacaine was injected. All patients remained in the sitting position for 10 min immediately before and after surgery; the block was tested using a long surgical toothless clamp and modified Bromage scale. A successful block was defined as one that was sufficient to proceed with the surgery without any supplementation. The dose of bupivacaine given to the next patient was guided by modified Dixon's up-and-down method using 0.5 mg as a step size. Patients' ability to position themselves, ambulation time, time of hospital discharge, patient and surgeon satisfaction, and any intraoperative or postoperative complication were recorded. The minimal effective dose of hyperbaric bupivacaine for successful saddle block for 50% (ED 50 ) of patients was determined by calculating the midpoint dose of all independent pairs of patients after at least seven crossover points. Results The ED 50 of hyperbaric bupivacaine for successful saddle block for perianal surgeries was 1.9 mg (95% confidence interval = 1.7-2.1 mg). There were zero motor blockade, early ambulation, short time to void, and early hospital discharge, as well as no complications and excellent patient and surgeon satisfaction. Conclusion The ED 50 of spinal hyperbaric bupivacaine for saddle block for perianal surgery is 1.9 mg (95% confidence interval = 1.7-2.1 mg). This block is reliable and has short duration, no complication, and excellent patient and surgeon satisfaction.

Association of lipophilic opioids and hyperbaric bupivacaine in spinal anesthesia for elective cesarean section. Randomized controlled study.

To evaluate the efficacy and side-effects of fentanyl and sufentanil combined with hyperbaric spinal bupivacaine in elective cesarean section. A prospective, randomized, double-blind study with 64 term parturients, distributed into 2 groups according to the opioid combined with hyperbaric bupivacaine 0.5% (10mg): GF - fentanyl (25 µg) and GS - sufentanil (5.0 µg). The latency and maximum sensory block level; degree and duration of motor block; duration and quality of analgesia; maternal-fetal repercussions were evaluated. This was an intention-to-treat analysis with a 5% significance level. The latency period, maximum sensory block level, motor block degree and perioperative analgesia were similar in both groups. Motor block and analgesia had a longer duration in the sufentanil group. Maternal adverse effects and neonatal repercussions were similar. The incidence of hypotension was higher in the fentanyl group. In both groups, there was a predominance of patients who were awake and either calm or sleepy. The addition of fentanyl and sufentanil to hyperbaric subarachnoid bupivacaine was shown to be effective for the performance of cesarean section, and safe for the mother and fetus. Analgesia was more prolonged with sufentanil.

English

OBJECTIVE: Spinal Anesthesia is the most preferred technique of anesthesia for lower segment caesarean section which provides effective pain relief during intraoperative and initial postoperative period. Various intrathecal adjuvant for postoperative pain relief have been tried which provide suboptimal analgesia and various side effects on maternal and fetus. We planned to assess the duration of analgesia by comparing intrathecal hyperbaric bupivacaine with preservative free ketamine and hyperbaric bupivacaine alone in parturient undergoing caesarean section. METHODS: A prospective, randomized, controlled study was conducted on 100 pregnant patients belonging to ASA I & II scheduled for LSCS under spinal anesthesia. Study comprised of two groups of 50 patients each. The first group received 2 ml of Hyperbaric Bupivacaine 0.5%+25 mg Preservative free Ketamine while group II received 2 ml of Hyperbaric Bupivacaine 0.5%. RESULTS: The mean duration of postoperative analgesia was160± 0.6minutes in group I and 120±0.7minutes in group II, P value <0.001. Incidence of hypotension and bradycardia was less in group I as compared to that of group II. Apgar score was statistically insignificant in both the groups. CONCLUSIONS: Addition of 25mg preservative free ketamine to hyperbaric bupivacaine in spinal anesthesia for LSCS significantly prolongs the duration of postoperative analgesia with better intraoperative hemodynamically stability and without any adverse effect on neonates.

English

BACKGROUND: Intrathecal adjuvants has gained popularity with the aim of prolonging the duration of block, quality of block and decreased resource utilization compared with general anaesthesia. However they are not free from side effects. We evaluated the effect of addition of intrathecal clonidine (45 micgm) to hyperbaric bupivacaine on perioperative and neonatal outcome following lower segment caesarean section. Study period: January -July 2012. METHODS: 60 female Patients undergoing elective cesarean section (LSCS) were randomly allocated to two groups of 30 each to receive intrathecally either 10 mg hyperbaric bupivacaine alone(group B) or 45 µg of clonidine (group C), added to 10 mg hyperbaric bupivacaine. The onset time to reach T 6 sensory and Bromage 3 motor level, the regression time for L1 sensory and Bromage 0 motor block, Sedation scores, hemodynamic changes, APGAR score and side effects were recorded. RESULTS: Onset of bromage 3 motor block and time to reach T 6 sensory dermatome level was statistically similar between group B and group C. The time for regression of sensory block to L1 dermatome was increased by addition of clonidine (p <0.001 B vs. C). The duration of postoperative analgesia was 164.42±24.64 min in group B and 260.71±38.46 min in group C which was statistically significant. (P<0.001). New born apgar score shows that addition of clonidine is safe for new borns. CONCLUSION: Addition of 45 μg clonidine to hyperbaric bupivacaine in spinal anesthesia for LSCS significantly prolongs the duration of postoperative analgesia without any increase in maternal and neonatal side effects.

Comparison of the effects of pre-anesthetic administration of normal saline, ringer and voluven on the spread of sensory block with hyperbaric bupivacaine spinal anesthesia.

Background:Spinal anesthesia is an important and commonly used method for surgical anesthetic in operating rooms. However, even with identical drug dosage and administration mode, the extent of drug distribution in vivo is highly variable and difficult to control. Preanesthetic administration of fluids immediately before spinal anesthesia (preload) is normal practice. The choice of fluid type may affect drug distribution as well as the duration and level of the block.Objectives:We examined whether preloads of normal saline, Ringer, or hydroxyethyl starch has different effects on the time it takes to reach maximum block, and the distribution and duration of spinal block level.Patients and Methods:This was a randomized trial and the 150 patients selected were evenly divided into three groups and given; normal saline, Ringer, or hydroxyethyl starch 130/0.4f luids. Preload was given at 10 mL/kg for the normal saline and Ringer groups, and 5 mL/kg for the hydroxyethyl starch group, 10 min before the spinal anesthesia. Sensory block levels were recorded every 5 min until 30 min after spinal anesthesia and then at 60 and 90 min. Time taken to reach maximum and median sensory block, maximum and median level of block, duration of block, and hemodynamic status were recorded.Results:There were no statistically significant differences in the demographic characteristics between the three groups. Maximum block was higher in normal saline compared to Ringer (P = 0.029). Time taken to reach maximum block was greater in Ringer compared to both normal saline (P = 0.001) and hydroxyethyl starch (P = 0.003). Normal saline had a longer duration of sensory block T10 compared to Ringer and hydroxyethyl starch (P = 0.03).Conclusions:Preload fluids have an impact on the level, distribution and duration of sensory block in spinal block. Of the three fluids, normal saline produced the greatest maximum and longest duration of block, whereas time taken to reach maximum block was longer in the Ringer group.

Effect of different doses of dexmedetomidine as adjuvant in bupivacaine -induced subarachnoid block for traumatized lower limb orthopaedic surgery: a prospective, double-blinded and randomized controlled study.

Improved pain management for blunt trauma to the lower extremity has shown to reduce morbidity, induce early ambulation and improve long-term outcomes. Dexmedetomidine; a selective α-2 agonist; has recently been used intrathecally in different doses to prolong spinal anaesthesia. We evaluated the effect of adding two different doses of dexmedetomidine to hyperbaric bupivacaine for spinal anaesthesia. The primary endpoints were the onset and duration of sensory, motor block and duration of analgesia. Eighty patients, (20-60yrs) posted for elective lower limb orthopedic surgery of traumatic origin under spinal anaesthesia were divided into 2 equal groups (Group D5&D10) in a randomized, double-blind fashion. In this prospective parallel group study, group D5(n=40) 3ml 0.5% hyperbaric bupivacaine+5μg dexmedetomidine in 0.5 ml of normal saline and group D10 (n=40) 3ml 0.5% bupivacaine+10μg dexmedetomidine in 0.5 ml of normal saline were administered intrathecally. Sensory and motor block onset times and block durations, time to first analgesic use, total analgesic need, postoperative VAS, hemodynamics and side effects were recorded for each patient. Though with similar demographic profile in both groups, sensory and motor block in group D10(p<0.05) was earlier than group D5. Sensory, motor block duration and time to first analgesic use were significantly longer and the need for rescue analgesics was lower in group D10(p<0.05) than D5. 24 h VAS score was significantly lower in group D10(p<0.05). Intergroup hemodynamics was comparable (p>0.05) without any appreciable side effects. Spinal dexmedetomidine increases the sensory, motor block duration and time to first analgesic use, and decreases analgesic consumption in a dose-dependent manner.

The effect of adding ketamine to bupivacaine in spinal anesthesia in day-case surgery

Objectives In this paper, we evaluate the effect of adding ketamine to spinal anesthesia in day-case surgery with regard to the time of onset of block, the duration of the block, hemodynamic variables, postoperative time to full motor power, time to walking, and side effects. Materials and methods Sixty patients scheduled for day-case surgeries under spinal anesthesia were studied in a prospective double-blinded randomized manner. Patients were allocated to receive either 3 ml hyperbaric bupivacaine (0.5%) (group I) or 2 ml hyperbaric bupivacaine (0.5%) combined with ΍ ml ketamine (25 mg) + ΍ ml normal saline (group II). Results The onset time and the duration of the block were shorter in group II than in group I. The postoperative time to walking, the time to full motor power recovery, and the duration of spinal analgesia were shorter in group II. There were no significant differences in hemodynamic variables or side effects. Conclusion Ketamine added to hyperbaric bupivacaine in spinal anesthesia provides a shorter time of onset of block, a shorter duration of the block, and a shorter time to full motor power and to walking postoperatively in day-case surgery.

Clonidine as an adjuvant to hyperbaric bupivacaine for spinal anesthesia in elderly patients undergoing lower limb orthopedic surgeries.

Background:In elderly patients, use of adjuvant with small doses of local anesthetics is a preferred technique for spinal anesthesia for lower limb surgeries. This study tested the hypothesis that addition of small doses of clonidine augments the spinal block levels produced by hyperbaric bupivacaine in elderly without affecting the side-effects if any of clonidine in these patients.Materials and Methods:This was a prospective, randomized, double-blind study. Above 60 years male patients were allocated to three equal groups. Group C received 9 mg hyperbaric bupivacaine without clonidine while Group C15 and Group C30 received 15 μg and 30 μg clonidine with hyperbaric bupivacaine respectively for spinal anesthesia. Effect of clonidine on sensory block levels was the primary study outcome measure. Motor blockade and hemodynamic parameters were also studied.Results:A significantly higher median block levels were achieved in Group C15 (P < 0.001) and Group C30 (P = 0.015) than Group C. Highest median sensory block level, the mean times for sensory regression to T12 level and motor block regression were statistically significant between Groups C15 and C and between Groups C30 and C. On comparison of fall in systolic blood pressure trends, there was no significant difference in the clonidine groups as compared with the control group.Conclusions:In elderly patients, clonidine when used intrathecally in doses of 15 μg or 30 μg with bupivacaine, significantly potentiated the sensory block levels and duration of analgesia without affecting the trend of systolic blood pressure as compared to bupivacaine alone. Clonidine in doses of 30 μg however facilitated the ascent of sensory level block to unexpectedly higher dermatomes for a longer time.

A comparison of the effects of hyperbaric and isobaric bupivacaine spinal anesthesia on hemodynamics and heart rate variability.

To compare the effects of hyperbaric and isobaric bupivacaine spinal anesthesia on hemodynamics and heart rate variability (HRV) in nonobstetric surgery. Sixty patients were randomly allocated to 2 groups. Group I (n = 30) received 15 mg (3 mL) of hyperbaric bupivacaine and Group II (n = 30) received 15 mg (3 mL) of isobaric bupivacaine for spinal anesthesia. Hemodynamic parameters were recorded before and after spinal anesthesia over 30 min. Analyses of HRV were performed on the day of surgery, after volume loading, and 20 min after spinal injection. Low frequency (LF) values, high frequency (HF) values, and LF/HF ratios were recorded. The incidences of hypotension and alterations of HRV parameters in both groups were investigated. The incidence ofhypotension was 26.6% and 23.3% in Groups I and II, respectively. There were no significant differences in the LF and HF values and LF/HF ratios between groups. In Group I, LF/HF ratios were significantly lower and HF values were significantly higher at 20 min after spinal anesthesia, in comparison to the baseline value (P < 0.05). Hyperbaric bupivacaine caused a significantly greater decrease in LF/HF ratios and a significantly greater increase in HF values.

Efficacy of low dose hyperbaric bupivacaine in spinal anaesthesia for LUCS

Spinal Anaesthesia (SAB) is a popular anaesthetic technique in LUCS. SAB is performed in sitting and lateral position. The aim of this study is to explore the efficacy of spinal anaesthesia ie, height of block and haemodynamic changes with low dose hyperbaric bupivacaine in different position in LUCS. Total 80 of ASA grade I &amp; II elective LUCS patient preloaded with 800-1000 ml of isotonic fluid were allocated randomly to receive different doses (10 mg, 12 mg,) of 5% Hyperbaric bupivacaine at L4-L5 interspaces in sitting (S group) and in lateral (L group) position to compare the height of block and haemodynamic changes. In sitting position in 10 mg dose group (S 10) adequate block developed in 7 patients out of 20 (35%) with no fall of systolic BP, in 12 mg dose group (S12) adequate block developed in 14 patients out of 20 (70%) with fall of systolic BP&gt;1/3rd in 2 patients (10%). In lateral position groups (L group) with 10 mg dose ((L 10 group), 17 patients out of 20 got adequate block (85%) with fall of systolic BP&gt;1/3rd in 2 patients out of 20 (10%) and in 12 mg dose group (L 12) adequate block in 20 patients out of 20 (100%) with fall of systolic BP&gt;1/3rd in 5 patients out of 20 (25%). So block height with low dose of Hyperbaric Bupivacaine for caesarean section is more predictable and haemodynamically stable in lateral position DOI: http://dx.doi.org/10.3329/bmjk.v45i1-2.13624 Bang Med J (Khulna) 2012; 45 : 15-18

The effects of single-dose intravenous dexmedetomidine on hyperbaric bupivacaine spinal anesthesia

Dexmedetomidine, a selective α2-adrenoceptor agonist, has analgesic and sedative effects. The purpose of this study was to investigate the effects of small, single-dose intravenous dexmedetomidine administration after hyperbaric bupivacaine spinal anesthesia. Sixty adult patients classified as American Society of Anesthesiologists physical status 1 or 2 and scheduled for lower extremity surgery under spinal anesthesia were studied. Patients were randomly assigned to one of three groups and administered hyperbaric intrathecal bupivacaine 12mg. 5min after spinal anesthesia, patients in groups 1, 2, and 3 received normal saline 10ml, dexmedetomidine 0.25μg/kg, and dexmedetomidine 0.5μg/kg, respectively, over 10-min intravenous administration. The onset time, maximum block level, two-dermatome sensory regression time, duration of motor and sensory anesthesia, and side effects were assessed. The two-dermatome sensory regression time was significantly increased in groups 2 and 3. The duration of motor and sensory anesthesia was significantly increased in group 3. Onset time, maximum block level, level of sedation, and incidence of hypotension and treatment-needed bradycardia were no different among the groups. Single-dose intravenous dexmedetomidine 0.25-0.5μg/kg, administered 5min after intrathecal injection of hyperbaric bupivacaine, improved the duration of spinal anesthesia without significant side effects. This method may be useful for increasing the duration of spinal anesthesia, even after intrathecal injection of local anesthetics.

Spinal anaesthesia for brachytherapy for carcinoma of the cervix: a comparison of two dose regimens of hyperbaric bupivacaine

Objectives : Spinal anaesthesia can be suitably performed for a variety of day-stay (ambulatory) surgical procedures. The time taken for adequate recovery to allow discharge home from hospital is an important consideration. The purpose of this study was to compare the suitability of two different doses of hyperbaric bupivacaine for spinal anaesthesia for day-stay brachytherapy for carcinoma of the cervix. Design: This was a prospective, randomised, double-blind study. Setting and subjects: Forty female patients, presenting to Groote Schuur Hospital for brachytherapy for carcinoma of the cervix, were randomised to receive either 5 mg or 9 mg (1 ml or 1.8 ml) of 0.5% hyperbaric bupivacaine, plus 15 μg fentanyl via the L3/L4 interspace. Results : Patients receiving the lower dose could be discharged from the recovery room in a shorter time (p-value < 0.01). The time taken to achieve hospital discharge criteria was significantly shorter in the group receiving the lower dose [a mean time of 235 (206-264) vs. 280 (263-297) minutes, p-value < 0.01]. There was significantly less motor block in the low-dose group (p-value < 0.001). Patient satisfaction regarding motor block was similar in the two groups (p-value = 0.96). There was a trend towards a higher number of inadequate spinal blocks in the low-dose group (p-value = 0.34). Conclusion: Our study suggests that a dose that is closer or equivalent to that of the high-dose group (9 mg bupivacaine plus 15 μg fentanyl) is preferable for brachytherapy for carcinoma of the cervix in ensuring consistent and reliable spinal anaesthesia in this patient population. Keywords: spinal, anaesthesia, bupivacaine, brachytherapy, ambulatory, day case

The effect of addition of intrathecal clonidine to hyperbaric bupivacaine on postoperative pain after lower segment caesarean section: A randomized control trial

Background:Intrathecal clonidine prolongs spinal anesthesia but the optimum dose to be used in cesarean delivery is not yet known. We evaluated the effect of addition of intrathecal clonidine to hyperbaric bupivacaine on postoperative pain after lower segment caesarean section.Methods:A total of 105 parturients carrying a singleton fetus at term, scheduled to undergo elective LSCS under spinal anesthesia were randomized in a double blind fashion to one of the three groups. Group BF (n=35) received 2 ml of 0.5% hyperbaric bupivacaine+25 μg fentanyl, Group BC50 (n=35) received 2 ml of 0.5% hyperbaric bupivacaine+50 μg clonidine, Group BC75 (n=35) received 2 ml of 0.5% hyperbaric bupivacaine+75 μg clonidine.Results:The duration of postoperative analgesia was 184.73±68.64 min in group BF, 360.71±86.51 min in group BC50 and 760.50±284.03 min in group BC75, P<0.001. The incidence of hypotension was comparable, P=0.932, whereas the incidence of nausea and pruritis was significantly lower in groups BC50 and BC75 as compared to group BF, P<0.001. No other side effects of intrathecal clonidine were detected. Neonatal outcome was similar in all the three groups.Conclusions:Addition of 75 μg clonidine to hyperbaric bupivacaine in spinal anesthesia for LSCS significantly prolongs the duration of postoperative analgesia without any increase in maternal side effects. There was no difference in neonatal outcome.

A Comparison of Spinal Anesthesia with Levobupivacaine and Hyperbaric Bupivacaine for Cesarean Sections: A Randomized Trial

Purpose: Levobupivacaine showed a lower risk of cardiovascular and central nervous system (CNS) toxicity than bupivacaine which is the most popular local anesthetic agent in obstetric practice. 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. The combinations 10 mg levobupivacaine (0.5%) + fentanyl (15 μcg) for Group LF (n = 30) patients, 10 mg hyperbaric bupivacaine (0.5%) + fentanyl (15 μcg) for BF (n = 30) patients were intrathecally administrated a total of 2.3 cc. 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 BF. It was observed that in Group BF, the evolution of the motor block was faster and lasted longer. Whereas hypotension, bradycardia and nausea were less in Group LF, the need for ephedrine was higher in Group BF (p < 0.05). Conclusion: Since motor block time is shorter, and side effects like hypotension, bradycardia and nausea are less, the combination of levobupivacaine + fentanyl can be a good alternative in cesarean sections.