Infraumbilical Surgeries Research Articles

EFFECT OF PREVIOUS SCORPION BITE ON THE EFFICACY OF INTRATHECALLY ADMINISTERED LEVOBUPIVACAINE IN SUBARACHNOID BLOCK

Objectives: Local anesthetics administered by spinal anesthesia acts through sodium channels. Mutations of sodium channels may be responsible for resistance to local anesthetic agents. The scorpion venom contains neurotoxins that block the sodium channels. In view of the high prevalence of scorpion stings in our region and observation of failure of spinal anesthesia in patients with a history of scorpion stings in routine practice, the present study is planned. Methods: Forty patients of the American Society of Anesthesiologists Grade I or II who were undergoing infraumbilical surgery were divided into two groups as S (patients with h/o scorpion bite) and C (patients with no such history). The subarachnoid block was given with 3.2 ml of injection Levobupivacaine 0.5% heavy using 26 gauzes Quincke spinal needle. A blind observer recorded a sensory block using a needle prick and a motor block using the Bromage scale. Onset of sensory and motorized block, time to peak of sensory, and motor block and its relation to number of scorpion bites were observed in both the groups. Results: The onset of sensory (2.61±1.68 mins) and motor blockade (2.91±1.80 mins) was significantly delayed in Group S (p=0.010 and 0.004, respectively). Time to peak of sensory and motor blockade was also prolonged in Group S (6.45±2.83 mins and 7.8±3.95 mins) compared to Group C (3.60±0.84 mins and 4.56±1.30 mins) which was statistically significant (p<0.05). Patients who had previous scorpion bites (Group S) had a significant failure rate of spinal anesthesia compared to the control group. Conclusion: In this study, it was observed that the patients with scorpion bites had a significant failure rate of spinal anesthesia, suggesting probable resistance to the local anesthetic agents.

A COMPARATIVE STUDY BETWEEN DEXAMETHASONE AND MAGNESIUM AS AN ADJUVANT TO ROPIVACAINE IN CAUDAL ANALGESIA IN PEDIATRIC PATIENTS UNDERGOING INFRAUMBILICAL SURGERIES

BACKGROUND: Caudal analgesia is the most commonly used technique for intraoperative and postoperative analgesia. Adjuvants are the one which prolong analgesia and free of side effects. We compared the OBJECTIVE: analgesic effects and side-effects of dexamethasone and magnesium added to ropivacaine for caudal analgesia in pediatric patients undergoing infraumbilical surgeries. The comparative study was conducted after obtaining a MATERIALS AND METHODS pproval from ethical committee. Written informed consent was obtained from parents of patients on day before the surgery.The comparative study was conducted on 75 patients with ASA class I and II, aged between 3-8 yrs scheduled for infraumbilical surgeries were included in this study.Study has been done under three groups with each group containing25 patients. Group 1(control) 0.5ml/kg of injection ropivacaine 0.2% alone. Group 2: 0.5ml/kg of injection ropivacaine 0.2% and magnesium 50mg. Group3:0.5ml/kg of injection ropivacaine 0.2% and dexamethasone 0.1mg/kg. P value <0.05 was considered statistically signicant. There was a signicant RESULTS: prolongation of duration of analgesia in study groups who received dexamethasone and magnesium as compared to ropivacaine alone. Regarding the intensity and duration of analgesia there was a statistically signicant difference between two groups, dexamethasone provides longer duration of analgesia when compared to magnesium. None of the adjuvants results in either prolonged or excess sedation. No side effects were encountered in either group. When CONCLUSION: compared to magnesium, dexamethasone added to ropivaciane provide longer duration of caudal analgesia without any side effects

Low Dose Bupivacaine (0.25%) with Fentanyl vs Ropivacaine (0.25%) with Fentanyl for Caudal Analgesia in Paediatric Patients: A Randomised Clinical Study

Introduction: Caudal epidural block is one of the most common regional techniques in paediatric anaesthesia for infraumbilical surgeries. Though bupivacaine is widely used because of its long duration, ropivacaine is a newly emerging drug having differential neuraxial blockade with less motor block and reduced cardiovascular and Central Nervous System (CNS) toxicity. To further increase the duration and quality various adjuvants have been added. Aim: To compare low dose bupivacaine-fentanyl with ropivacaine-fentanyl in terms of hemodynamic stability, duration of analgesia, postoperative pain, level of sedation, and side-effects profile among patients undergoing infraumbilical surgery. Materials and Methods: A double-blind, randomised study was conducted on 60 children undergoing elective infraumbilical surgery. Patients were randomly divided into two groups of 30 each into Bupivacaine-Fentanyl (BF) group and RopivacaineFentanyl (RF) group, using a simple envelope method. After securing airway, caudal block was given. Group BF received 0.25% bupivacaine 0.5 mL/kg with fentanyl 0.5 mcg/kg and Group RF received 0.25% ropivacaine 0.5 mL/kg with fentanyl 0.5 mcg/kg. Postoperative pain was assessed using the Face, Legs, Activity, Cry, Consolability (FLACC) pain assessment scale, for 12 hours. The hemodynamics, duration of analgesia, rescue analgesia requirement and side effects (bradycardia, hypotension, respiratory depression, retching, urinary retention, vomiting) were noted and analysed statistically. Results: The mean duration of analgesia in the BF group was 270±46.60 minutes and in the RF group was 430±68.83 minutes (p-value <0.001). Patients requiring rescue analgesia were 12 in Group BF and 5 in Group RF. Mean FLACC reached ≥4 at 4.5 hours in group BF and at 7 hours in group RF. There was no significant difference in hemodynamics and side-effects profile (bradycardia, hypotension, respiratory depression, retching, urinary retention, vomiting) between the two groups. Conclusion: Low dose caudal ropivacaine-fentanyl combination is superior to that of caudal bupivacaine-fentanyl with respect to duration and intensity of intraoperative and postoperative analgesia.

A comparative study to evaluate the efficacy of dexmedetomidine and nalbuphine as an adjuvant with 0.5% ropivacaine under epidural anaesthesia in patients undergoing various infraumblical surgeries

A comparative study to evaluate the efficacy of dexmedetomidine and nalbuphine as an adjuvant with 0.5% ropivacaine under epidural anaesthesia in patients undergoing various infraumblical surgeries

A Study to Compare the Prophylactic use of Midazolam Versus Tramadol for Anti-shivering effect in Infra-umbilical Surgeries under Spinal Anaesthesia in Post-operative Period

A Study to Compare the Prophylactic use of Midazolam Versus Tramadol for Anti-shivering effect in Infra-umbilical Surgeries under Spinal Anaesthesia in Post-operative Period

Comparison of Bupivacaine with Two Different Doses of Clonidine under Spinal Anaesthesia in Infraumbilical SurgeriesA Randomised Clinical Study

Introduction: Spinal anaesthesia is known as a safe and effective way to give anaesthesia during infraumbilical and lower limb surgeries. Intrathecal clonidine is a safe non opioid adjuvant used with local anaesthetics to prolong sensory and motor block, promotes sedation and analgesia. Aim: To compare the effects of bupivacaine with two different doses of clonidine under spinal anaesthesia in infraumbilical surgeries. Materials and Methods: This randomised double-blinded study was conducted in the Department of Anaesthesiology at Hind Institute Of Medical Science, Sitapur, Uttar Pradesh, India. The duration of the study was 19 months, from January 2021 to August 2022. A total of 60 patients (36 males and 24 females) were enrolled in the study and were randomly assigned to one of two groups (group A and group B) of 30 patients each. Group A bupivacaine heavy 12.5 mg with 15 mcg of clonidine, total volume 3 mL and group B bupivacaine heavy 12.5 mg with 30 mcg of clonidine, total volume 3 mL. The study parameters were: onset of sensory and motor block, duration of postoperative analgesia and any side effects (hypotension, bradycardia, sedation or any other). The statistical analysis was done using Statistical Package for Social Sciences (SPSS) Version 21.0. Results: The mean age of the study participants group A (44.51±12.84) years and group B (42.28±13.12) years. The demographical data showed comparable findings. The mean of onset of sensory (160.37±33.64) seconds and motor block (197.2±12.36) seconds in group B was statistically lower than group A. The mean duration of analgesia in group A (302.58±18.62) minutes was lower than group B (318.73±29.46) minutes. The mean Visual Analogue Scale (VAS) score was higher at every follow-up in group A as compared to in group B. The mean Ramsay sedation score was significantly higher in Group B at every follow-up than in group A. Conclusion: Spinal anaesthesia performed with 0.5% bupivacaine heavy with 30 mcg clonidine was proven to be a more effective adjuvant in providing early onset of the sensory and motor blockade intraoperatively and prolongation of the duration of effective postoperative analgesia when compare to 15 mcg clonidine.

Comparison of post-operative analgesic effect of dexmedetomidine versus dexamethasone as adjuvants to caudal levobupivacaine in infraumbilical surgeries among pediatric patients: A randomised controlled double blind study

Comparison of post-operative analgesic effect of dexmedetomidine versus dexamethasone as adjuvants to caudal levobupivacaine in infraumbilical surgeries among pediatric patients: A randomised controlled double blind study

A Comparative Study Between Oral Pregabalin and Gabapentin in Prolongation of Postoperative Pain Relief after Spinal Anaesthesia

Background: Management of pain and its complications in postoperative period still a major challenge. Generally,the pathophysiology and treatment of postoperative pain and neuropathic pain have been considered as separateand distinct, though, there is considerable overlap in their pathophysiology.Materials & Methods: The present study was designed as randomized, double blinded, parallel group, open labeltrial to compare the efficacy of pregabalin and gabapentin as preemptive analgesics in surgery below umbilicusunder spinal anaesthesia. This study was conducted under the Department of Anesthesiology, in the R.G. KarMedical College & Hospital, Kolkata. Sixty two patients, aged between 20-50 yrs, ASA grade I and II, scheduled toundergo infra umbilical surgery, were randomly divided into 2 groups. In group G (n=31) they received 1200 mggabapentin, in group P (n=31) they received 300 mg pregabalin capsules, orally with sips of water, 1 hour beforethe induction of anesthesia. Routine monitoring in the form of NIBP, Pulse oxymetry and ECG were instituted onarrival in Operation Theatre. All patients were preloaded with 10 ml/kg lactated Ringer’s solution before beingadministered spinal anesthesia. Spinal anesthesia was instituted with 3 ml of 0.5% bupivacaine (15 mg) at L3 – L4/ L4 - L5 level.Results: All the groups were comparable in respect to demographic data, ASA physical status, the mean durationof surgery and the type of surgeries performed between them. In the 24 hrs of post-perative period the mean VASscores at rest of Groups P was always significantly lower than those of Group G. The time to first dose of rescueanalgesic was compared between the groups, as in Group G (gabapentin group) rescue analgesic was given after9.41±1.84 hrs, while in Group P (pregabalin group) rescue analgesic was required after 15.38±3.52 hrs. Hence, ascomparison of pregabalin and gabapentin could be made for these parameters, and it was possible to come to aconclusion as the superiority of pregabalin over gabapentin.Conclusion: In conclusion, a single oral dose of pregabalin given preoperatively provides better postoperative pain control and decreases postoperative rescue analgesic consumption compared to single dose of gabapentin,based on lower mean VAS scores at rest.

Role of Prophylactic Intramuscular Glycopyrrolate in Preventing Hypotension and Bradycardia in Patients Undergoing Elective Lower Limb Surgeries under Spinal Anaesthesia: A Randomised Placebo-controlled Study

Introduction: Spinal anaesthesia is an extensively used anaesthetic technique for infraumbilical surgeries. Despite its many advantages, hypotension and bradycardia are two common complications. The incidence of bradycardia following spinal anaesthesia is higher in young adults. Although a few previous studies have observed that intramuscular glycopyrrolate is effective in preventing spinal-induced bradycardia and hypotension in elderly and parturient patients, there is a lack of reported studies in the young population. Aim: To evaluate the role of intramuscular glycopyrrolate in the prevention of bradycardia and hypotension in adult patients undergoing lower limb surgeries. Materials and Methods: A randomised, parallel-group, doubleblind, placebo-controlled study was conducted in the Department of Anaesthesiology at Calcutta National Medical College, Kolkata, West Bengal, India. The duration of the study was 15 months, from July 2021 to September 2022. A total of 60 patients aged 18-45 years, of either sex, with American Society of Anaesthesiologists (ASA) physical status I and II, undergoing elective lower limb surgeries under spinal anaesthesia. The patients were randomised into two groups: group G received intramuscular glycopyrrolate 1 mL (0.2 mg) and group N received intramuscular normal saline 1 mL 15 minutes prior to spinal anaesthesia. Hyperbaric bupivacaine (0.5%) 3 mL and fentanyl (25 mcg) 0.5 mL were injected intrathecally. Haemodynamic parameters were monitored. All data were analysed using appropriate statistical tests. A p-value of <0.05 was considered statistically significant. Changes in Heart Rate (HR) were considered the primary outcome variable. The secondary outcome variables were changes in Mean Arterial Pressure (MAP), incidence of bradycardia and hypotension, phenylephrine requirement, and incidence of dry mouth. Results: The mean age of the study participants of group G and group N was 34.17 years and 33.63 years. The two groups were comparable in terms of demographic profile. In comparison to group N, patients in group G showed a significantly higher HR throughout the intraoperative period (p<0.001) and at 60 minutes in the postoperative period. The incidence of hypotension was significantly higher in group N (53.33%) compared to group G (3.33%, p<0.001), and the MAP was lower in group N compared to group G in the intraoperative period. The number of patients requiring phenylephrine was also higher in group N (53.33%) compared to those in group G (3.33%). Conclusion: Prophylactic use of intramuscular glycopyrrolate can maintain stable haemodynamics in patients undergoing lower limb surgeries under spinal anaesthesia. It can maintain a higher HR and reduces the incidence of hypotension following spinal anaesthesia.

Comparison of intrathecal bupivacaine with different doses of clonidine for spinal anesthesia in adults: A systematic review

Background: Evaluating the optimal dose of intrathecal clonidine adjuvant has a great impact on day-to-day practice of anesthesia, as spinal anesthesia is one of the most commonly performed anesthetic procedure.Objectives: Evaluate for the minimal dose of intrathecal clonidine as an adjunct to bupivacaine heavy for spinal anesthesia that can produce optimal sensory and motor blockade with minimal hemodynamic effects.Methods: Randomized control trials carried out on adult patients, of both genders undergoing elective infraumbilical surgeries under spinal anesthesia with bupivacaine heavy and different doses of clonidine having ethical committee approval were included and articles published in non-English languages were excluded. Databases (PubMed and Google Scholar) and websites of the Indian Journal of Anaesthesia and anesthesia essays and researches journals were systematically searched and interpreted in accordance with the PRISMA guidelines. Quality assessment was done using the Risk of Bias assessment 2.O tool. The mean time taken for the onset of sensory and motor blockade, mean duration of sensory and motor blockade and significant adverse effects were the key outcome variables. Nonstatistical synthesis of quantitative data of the selected articles was done.Results: The efficacy in terms of sensory and motor blockade was comparatively more with 1 μg/kg of intrathecal clonidine than with lower doses, however, cardiovascular adverse effects were dose-dependent, with 15 μg intrathecal clonidine causing least cardiovascular disturbance.Conclusion: 15–30 μg intrathecal clonidine as an adjunct to bupivacaine heavy would produce optimal sensory and motor block with minimal hemodynamic disturbances.

Ultrasound-guided versus Conventional Caudal Blocks in Children: A Randomised Clinical Study

Introduction: Caudal epidural block is a popular regional anesthetic technique in children undergoing infraumbilical surgeries. Conventionally, a landmark-guided method is used to perform caudal epidural blocks. Although widely practiced, this method is associated with procedural difficulties such as multiple attempts, decreased success rates at the first puncture, as well as higher rates of complications including dural puncture, rectal injury, and intraosseous/intravenous (i.v.)/subcutaneous injections. In order to overcome the shortcomings of the conventional technique, various other methods have been described in clinical practice, including imaging-assisted techniques with fluoroscopy and Ultrasound (US). Aim: To compare the overall block success rates between the conventional and US-guided methods of caudal blocks in children. Materials and Methods: The present randomised clinical study was conducted in the Department of Anesthesiology, St. John's Medical College, Bengaluru, Karnataka, India, from November 2019 to September 2021. Sixty-four children, aged 1-8 years, belonging to the American Society of Anesthesiologists (ASA) physical status grade I and II, and undergoing elective inguinal hernial surgery were included in the study. After induction of general anesthesia, the children were administered caudal blocks based on the assigned groups: group A (conventional) - patients were given 0.5 mL/kg of 0.25% bupivacaine after the needle entered the sacral canal, and group B (USG) - patients were given 0.5 mL/kg of 0.25% bupivacaine immediately after the needle was visualised piercing the sacrococcygeal ligament in the longitudinal view. The parameters studied were overall block success rates, block performance times, and the number of attempts taken. Descriptive statistics were reported using mean±Standard Deviation (SD) for continuous variables and number or percentage for categorical variables. Independent t-test and Mann-Whitney U test were used for normally distributed and non-normally distributed variables, respectively. Chi-square test was used to analyse differences between categorical variables. Results: A total of 64 children of both genders, aged 1-8 years, belonging to ASA physical status I and II, were included in the study. Overall block success rates were comparable between the two groups, with 28 (87.5%) in group A and 30 (93.8%) in group B. The mean block performance time was longer in group B (2.781±1.2439 minutes) compared to group A (1.578±0.5835 minutes) (p-value<0.001). The number of attempts was lower in group B, with 100% success in the first attempt, as opposed to 68.8% in group A (p-value<0.05). Conclusion: Ultrasound-guided caudal block does not improve overall block success rates or block performance time, but it does improve success rates at the first attempt and thereby reduces the number of attempts.

Evaluation of analgesic efficacy of magnesium sulfate as an adjuvant to caudal bupivacaine in pediatric infraumbilical surgeries – A prospective randomized double-blind study

Evaluation of analgesic efficacy of magnesium sulfate as an adjuvant to caudal bupivacaine in pediatric infraumbilical surgeries – A prospective randomized double-blind study

Cardiovascular Effects of Adding Epinephrine to Bupivacaine in Children Undergoing Caudal Block: A Double-blind Randomized Clinical Trial

Background: Caudal block is a common, safe, and effective anesthetic technique for lower abdominal, urological, and lower extremity surgeries in pediatrics. Objectives: This study aimed to evaluate the cardiovascular effects of adjuvant epinephrine in the caudal block on heart rate and blood pressure changes in children. Methods: This double-blind, randomized clinical trial was performed on 60 children who underwent elective infra-umbilical surgeries. They were under general anesthesia with midazolam, fentanyl, lidocaine, and propofol. The patients were ventilated through laryngeal mask airway (LMA), and anesthesia was maintained with sevoflurane in O2 and N2O mixture. The intervention group received a caudal block with 0.2% bupivacaine and 1/200000 epinephrine (1 mL/kg), while the control group received a caudal block without epinephrine. Heart rate, blood pressure, and ECG were monitored before the block and in the first, fifth, and 20th minutes after surgery. Results: The two groups showed no statistically significant differences in demographics and systolic and diastolic blood pressures. However, sinus arrhythmia was more prevalent in the study group in the first minute after the block (P < 0.001). No differences were observed in the incidence of arrhythmia in the fifth and 20th minutes after the block. Conclusions: It appears that epinephrine as an adjuvant to the caudal block does not have long-lasting effects after the block, except sinus tachycardia in the first minute. Considering that no changes in blood pressure and other hemodynamic parameters were observed, it seems that epinephrine can be used safely in the caudal block in pediatric patients.

A COMPARATIVE STUDY BETWEEN CAUDAL ROPIVACAINE AND ROPIVACAINE PLUS DEXAMETHASONE FOR INFRAUMBILICAL SURGERY IN PEDIATRIC PATIENTS

Background: Caudal block is one of the most popular regional block in children with high success rate for infra-umbilical surgeries. Among local anaesthetics ropivacaine provides a greater margin of safety, less motor blockade, less neurological and cardiac toxicity and similar duration of analgesia compared to bupivacaine. Addition of dexamethasone as an additive to local anesthesia decreases the postoperative rescue analgesia consumption.This study was designed to compare the effectiveness of intra-operative and postoperative analgesia on adding dexamethasone to 0.15% ropivacaine with 0.15%ropvacaine given alone. A prospective double blinded Materials: randomised controlled study was conducted consisting of 60 patients undergoing infra-umbilical surgeries under general anesthesia with Caudal block. Patients were randomised into two groups. Group A received 0.15% Inj.ropivacaine 1.5ml/kg with 1ml normal saline and Group B received 0.15% Inj.Ropivacaine 1.5ml/kg with 0.1mg/kg Inj.dexamethasone in caudal block Results: Mean FLACC pain score was comparable and statistically not signicant (P=0.083) in both groups upto 30min postoperatively. At 60min mean pain score in group A was 0.30 ± 0.54 and in group B was 0 (P=0.005) which was statistically signicant. In group A 40%(12) patients required rescue analgesia whereas in group B only 10%(3) patients required analgesia(P= 0.007) Patients remained hemodynamically stable throughout the procedure. After 60min Conclusion: postoperatively FLACC score was signicantly higher in group A as compared to group B. It concludes that addition of dexamethasone signicantly reduced postoperative pain and need for rescue analgesia without any side effects.

A Randomized Controlled Trial to Assess the Efficacy of a Pre-operative Virtual Operation Theatre Tour on Anxiety and Patient Satisfaction in Adults Undergoing Elective Surgery.

The study objective involves the evaluation of preoperative audiovisual information on the operation theater environment as a tool to relieve anxiety in patients posted for infra umbilical elective surgery under spinal anesthesia. Perioperative anxiety is detrimental to both intraoperative hemodynamic instability and postoperative recovery. The design was a single-center, prospective, randomized control trial. There were 120 patients in this study within the 18-60-year-old age range who were American Society of Anaesthesiologists (ASA)class I-II admitted for infra-umbilical surgery excluding lower segment cesarean section (LSCS) under spinal anesthesia. Patients were randomized into two groups: those who were not exposed to an audiovisual tour (NA) (n = 60) and those who were exposed to an audiovisual tour (A) (n = 60). The measurements are based on the demographic details of the patient; the visual analogue score (VAS); and the Amsterdam Preoperative Anxiety and Information Scale (APAIS) for anxiety, hemodynamic parameters i.e., blood pressure (BP), heart rate (HR), respiratory rate (RR), and patient satisfaction score (PSS) on a five-point Likert scale were noted perioperatively for both the groups. The main results showed a significant (p-value <0.05) decrease in VAS and APAIS for anxiety, HR, and PSS. This was observed during the intraoperative and postoperative periods in the A group in comparison to the NA group. The preoperative audiovisual virtual tour of the operation theater effectively reduces perioperative anxiety and stabilizes HR; it also improves the satisfaction of patients undergoing elective surgery under spinal anesthesia.

Arousal Time from Sedation during Spinal Anaesthesia Given with Propofol and Midazolam for Elective Infraumbilical Surgeries

Background: Arousal time is variable after sedation with spinal anesthesia after infraumbilical surgeries. Propofol and midazolam have been studied individually using the Observer’s Assessment of Awareness/Sedation (OAA/S) score and different other ways. So this present study was designed to compare the arousal time of sedation for propofol and midazolam using OAA/S scores.&#x0D; Materials and methods: A total of 60 patients were randomly assigned to receive either propofol (Group A, n =30) or midazolam (Group B, n = 30). All patients of Group A received bolus of propofol (1 mg/kg) followed by infusion at 3 mg/kg/h, Group B received bolus of midazolam (0.05 mg/kg), followed by infusion at 0.06 mg/kg/h. OAA/S score was noted at beginning and again during recovery. The time to achieve OAA/S score 5 was noted. Changes of pulse rate, O2 saturation and satisfaction score were noted.&#x0D; Results: Among the 60 patients gender distributions where male and female distributed evenly. Age group distributions revealed more patients were gathered in age group 31- 40 years and &gt;51 years. Regarding physical status most of the patients were at ASA physical status 1. It was found that propofol had better outcome than midazolam in terms of arousal time score and patient’s satisfaction score after surgery.&#x0D; Conclusions: A shorter arousal time from sedation during spinal anaesthesia can be achieved using propofol than arousal time with midazolam.&#x0D; Chatt Maa Shi Hosp Med Coll J; Vol.21 (2); July 2022; Page 18-21

Awake neuraxial anesthesia for infants undergoing infraumbilical surgery.

Awake neuraxial anesthesia techniques such as spinal anesthesia (SA) have been recently popularized and successfully used in infants for infraumbilical procedures. One caveat of these techniques is limited block duration. In this prospective study, we describe our single-center implementation of three approaches to awake neuraxial anesthesia (plain bupivacaine SA, bupivacaine with adjunctive clonidine SA, and combined spinal caudal anesthesia) based on expected surgical duration in 140 infants. We show that a wide range of infraumbilical procedures can be successfully performed in infants while maintaining the benefits of awake neuraxial anesthesia techniques. We hope our experience provides guidance to clinicians performing awake neuraxial anesthesia in infants in helping plan the appropriate anesthetic approach.

Comparison of Analgesic Effect of Dexmedetomidine versus Tramadol as Adjuvants to Caudal Ropivacaine in Infraumbilical Surgeries among Pediatric Patients: A Randomized Double Blind Interventional Study

Objective: To compare the postoperative analgesic effects of 0.2% ropivacaine with Dexmedetomidine (2 g/kg) and tramadol (2 mg/kg) among pediatric patients undergoing infra umbilical surgery.Material and Methods: This hospital based, randomized double blind interventional study included 60 pediatric patients, aged 1–7 years, having American Society of Anaesthesiology grade I and II, weighing 7-25 kg, and undergoing infraumbilical surgeries under general anesthesia. Subjects were randomly allocated into two groups to receive either: 2 mcg/ kg of Dexmedetomidine or 2 mg/kg of Tramadol, as adjuvant to 0.2% of Ropivacaine. Pain intensity was assessed using the pediatric observational Children’s Hospital of Eastern Ontario Pain Scale (CHEOPS) score. Rescue analgesia was given, when the CHEOPS score was ≥6. Duration of analgesia was defined as: the time period between administrations of block until rescue analgesia was given. Level of sedation was assessed by the Ramsay sedation score.Results: Kaplan Meier analysis showed that the median time to first rescue analgesia (duration of analgesia) was significantly (p-value&lt;0.001) prolonged with Dexmedetomidine (780 minutes; 95% CI: 760.68–799.32 minutes) as compared to Tramadol (648 minutes; 95% CI: 635.92–660.38 minutes). Mean emergence time and duration of sedation were also significantly prolonged with Dexmedetomidine as compared to Tramadol.Conclusion: In pediatric patients undergoing infraumbilical surgeries, Dexmedetomidine as adjuvant to Ropivacaine provides an advantage of longer post-operative analgesia and lack of opioid related adverse events associated with Tramadol.

A Comparison Between Intrathecal Levobupivacaine and Bupivacaine for Quality and Safety During Infraumbilical Surgeries.

Background Levobupivacaine toxicity reports are rare, and when they do occur, toxic symptoms are frequently treatable with minimal morbidity and mortality. However, levobupivacaine has not entirely replaced bupivacaine in clinical practice. Moreover, the experience of intrathecal anesthesia with levobupivacaine is not well documented. Hence, the purpose of this study is to assess the quality and duration of sensory and motor blockade of levobupivacaine and its side effects, if any, compared to intrathecal bupivacaine during infraumbilical surgeries. Methods After approval by the Institutional Ethical Committee of Kurunji Venkatramana Gowda (KVG) Medical College and Hospital, Sullia, 90 patients aged between 18 and65 years, of either sex, who were scheduled for elective abdominoperineal, urological, or lower limb surgeries under intrathecal anesthesia were enrolled in this prospective study fromJanuary 2013 to June 2014. The selected patients were randomly assigned to three groups of 30 each: group HB (3 mL of 0.5% hyperbaric bupivacaine), group IB (3 mL of 0.5% isobaric bupivacaine),and group IL (3 mL of 0.5% isobaric levobupivacaine). Motor blockade was assessed using the modified Bromage scale. Intergroup comparison was done using Tukey's post hoc test. The incidence of adverse effects was analyzed using a chi-squared test. Significance was defined as P<0.05. Results In our study, the mean age of patients in the three groups was comparable (P>0.05), i.e., group IB was 39.23±11.78 years, group HB was 43.63±11.33 years, and group IL was 39.8±12.07 years. The time of onset ofsensory block was 6.57±1.794 minutes in group IB, 2.30±1.343 minutes in group HB, and 4.57±1.960 minutes in group IL, and this variation was statistically highly significant (P<0.001). A total of 15 patients suffered hypotension intraoperatively, of which eight belonged to group HB, four to group IB, and the rest to group IL. Intraoperative or postoperative nausea/vomiting was seen in five patients in group IB, two patients in group HB, and one patient in group IL. In the postoperative period, the mean heart rate (HR) was 77.47±4.88/minute in group IB, 68.78±7.88/minutein group HB, and 72.15±8.83/minute in group IL. The data was statistically highly significant (P<0.001). Conclusion Our study revealed that 15 mg of isobaric levobupivacaine (3 mL of 0.5%), the new racemic isomer of bupivacaine, was intermediate in its anesthetic properties when compared to isobaric bupivacaine and hyperbaric bupivacaine. The onset of sensory and motor blockade is slower than hyperbaric bupivacaine but faster than isobaric bupivacaine with a higher level of maximum sensory block.

Efficacy of clonidine as an additive to levobupivacaine for epidural anesthesia and post-operative analgesia in infraumbilical surgeries – A randomized and double blind study

Background: Epidural anesthesia as a safe alternative to general anesthesia is commonly used for inducing anesthesia and post-operative analgesia in patients undergoing infraumbilical surgeries. The addition of an adjuvant not only increases the effectiveness of a local anesthetic by prolonging and intensifying the sensory blockade but also causes reduction in the dose of rescue analgesic agent in post-operative period. Clonidine is a potent and selective α-2-adrenoceptor agonist with analgesic potency. Aims and Objectives: This study was conducted to evaluate the efficacy of clonidine as an additive to levobupivacaine in infraumbilical surgeries. Materials and Methods: One hundred patients of American Society of Anesthesiologists Grade I or II who were undergoing infraumbilical surgery were randomly divided into two groups as levobupivacaine (L) and levobupivacaine with clonidine (LC). Patients were allocated to one of the two groups by computer generated random selection. Group L received 0.5% levobupivacaine (1.5 mg/kg) and Group LC received 0.5% levobupivacaine (1.5 mg/kg) with clonidine (2 μg/kg). The onset time for sensory, motor blockade, duration of anesthesia and duration of analgesia, and Visual Analog Scale (VAS) score were observed in both the groups. The hemodynamic variables such as heart rate, systolic and diastolic blood pressure, respiratory rate, and oxygen saturation at various time intervals were measured. Any untoward side effects were noted in both groups. Results: The onset of sensory (7.8±1.7 min) and motor blockade (10.9±1.9 min) were significantly faster in clonidine group. Duration of anesthesia and duration of analgesia were prolonged in Group LC (234.5±16.1 min, 412.8±48.3 min) compared to Group L (173.56±12.78 min, 269.2±24.2 min) which was statistically significant (P&lt;0.05). Similarly, clonidine group had less VAS score compared to control group. There was no significant change in the hemodynamic variables between the two groups. Hypotension and bradycardia were found more in clonidine group compared to the control group. Conclusion: Clonidine as an adjuvant to levobupivacaine prolongs the post-operative analgesia and the duration of anesthesia for infraumbilical surgeries.