Infraumbilical Surgeries Research Articles

Effect of Dexamethasone as an Adjuncton Efficacy of Ropivacaine in Caudal Block forPostoperative Analgesia in Paediatric Infra-Umbilical Surgeries: A Randomised Double-blind Controlled Study

Introduction: Caudal block is a routinely performed analgesic and anaesthetic technique in paediatric population undergoing various infra-umbilical surgeries. Various adjuvants have been used along with local anaesthetics like ropivacaine in single-shot caudal block for enhancing postoperative analgesia in paediatric infra-umbilical surgeries. Aim: To evaluate the efficacy of dexamethasone used as an adjuvant to 0.2% ropivacaine in caudal block for postoperative analgesia in paediatric patients. Materials and Methods: This was a randomised doubleblinded controlled study conducted on 80 paediatric patients (8 months-8 years), with American Society of Anesthesiologists (ASA) physical status I or II undergoing various infra-umbilical surgeries,at a tertiary care teaching institute from April 2019 to September 2019. These total subjects were randomly allocated into two groups. GroupR (n=40) administered 0.2% ropivacaine (1 mL/kg) while GroupRD (n=40) administered 0.2% ropivacaine (1 mL/kg) with dexamethasone (0.1 mg/kg) in caudal block. The duration of analgesia, postoperative pain scores (Face Legs Activity Cry Consolability (FLACC) score), rescue analgesic consumption in 24 hours, haemodynamic changes and side-effects were noted. The rescue analgesic (paracetamol 15 mg/kg oral) was given whenever FLACC ≥4. Standard qualitative and quantitative tests (unpaired student t-test, Chi-square test) were used to analyse and compare the results obtained. Results: The mean duration of analgesia was significantly longer in Group RD (745.21±146.91 min) as compared to GroupR (440.38±76.44 min); (p-value <0.001). The significantly lower FLACC pain scores were noted in patients in Group RD compared to Group R; (p-value <0.05). The rescue analgesic consumption was significantly lesser in Group RD in terms of requirement of number of doses of rescue analgesic than in Group R; (p-value <0.05). No significant haemodynamic changes or side-effects were observed in both groups; (p-value >0.05). Amongst postoperative complications noted, fever was observed in 1 patient (3.33%) and PONV in 2 patients (6.66%) in Group R. None complications were observed in the patients of RD group. Conclusion: Dexamethasone (0.1 mg/kg) was found to be safe and effective adjuvant to 0.2% ropivacaine for caudal block in children undergoing various infra-umbilical surgeries.

Comparative Study between Analgesic Effects of Intrathecal Administration of Midazolam Versus Tramadol with Bupivacaine for Infra-Umbilical Surgeries

Background: The administration of bupivacaine intrathecally as a regional anesthesia is commonly used to provide anesthesia for lower abdominal surgeries. The motor blockage of bupivacaine provides adequate blockage, which allows the surgeons to do their work comfortably and also provides effective postoperative analgesia in early postoperative period. However, adding adjuvants to the local anesthetics to prolong the period of postoperative analgesia after fading of the spinal anesthesia was tried in many studies. These supplements as regard to postoperative pain relief are beneficial as they decrease or abolish the need for the administration of analgesics and their associated complications. Objective: To compare the analgesic effect of intrathecal midazolam versus intrathecal tramadol when added to bupivacaine during spinal anesthesia after infra-umbilical surgeries. Patients and methods: In our study we included 80 patients scheduled for elective surgeries in the lower abdomen and lower limbs (infra-umbilical surgeries) under spinal anesthesia. They were randomly divided to one of two groups. Group M received 10 mg of hyperbaric bupivacaine + 2 mg midazolam, and group T received 10 mg of bupivacaine + 20 mg of tramadol (total is 3cc in both groups). The comparison was done by using the visual analogue scale (VAS) for assessing postoperative pain score and recording the duration of postoperative analgesia. Results: The postoperative analgesia duration was significantly higher in the tramadol group than midazolam group (P<0.05). Conclusion: Addition of 20 mg tramadol to bupivacaine during spinal anesthesia provides longer duration of analgesia when compared to intrathecal midazolam 2.0 mg.

Comparative Study between Analgesic Effects of Intrathecal Administration of Midazolam Versus Tramadol with Bupivacaine for Infra-Umbilical Surgeries

Background: The administration of bupivacaine intrathecally as a regional anesthesia is commonly used to provide anesthesia for lower abdominal surgeries. The motor blockage of bupivacaine provides adequate blockage, which allows the surgeons to do their work comfortably and also provides effective postoperative analgesia in early postoperative period. However, adding adjuvants to the local anesthetics to prolong the period of postoperative analgesia after fading of the spinal anesthesia was tried in many studies. These supplements as regard to postoperative pain relief are beneficial as they decrease or abolish the need for the administration of analgesics and their associated complications. Objective: To compare the analgesic effect of intrathecal midazolam versus intrathecal tramadol when added to bupivacaine during spinal anesthesia after infra-umbilical surgeries. Patients and methods: In our study we included 80 patients scheduled for elective surgeries in the lower abdomen and lower limbs (infra-umbilical surgeries) under spinal anesthesia. They were randomly divided to one of two groups. Group M received 10 mg of hyperbaric bupivacaine + 2 mg midazolam, and group T received 10 mg of bupivacaine + 20 mg of tramadol (total is 3cc in both groups). The comparison was done by using the visual analogue scale (VAS) for assessing postoperative pain score and recording the duration of postoperative analgesia. Results: The postoperative analgesia duration was significantly higher in the tramadol group than midazolam group (P<0.05). Conclusion: Addition of 20 mg tramadol to bupivacaine during spinal anesthesia provides longer duration of analgesia when compared to intrathecal midazolam 2.0 mg.

Comparative study of intrathecal fentanyl and clonidine as adjuvants to hyperbaric bupivacaine under spinal anaesthesia in infraumbilical surgeries

Background: Opioids are commonly used neuraxial adjuvants with local anaesthetics in subarachnoid block (SAB) for prolongation of analgesia, however Clonidine has shown to improve the quality of blockade without any neurotoxicity. This study assess the quality of SAB using intrathecal fentanyl and clonidine with bupivacaine in infraumbilical surgeries. Methods: After obtaining ethical clearance and informed consent 80 patients were randomly allocated into 2 groups, Group F received 15µg fentanyl and group C received 30µg clonidine with 12.5mg hyperbaric bupivacaine each. The onset time to reach peak sensory and motor level, 2 segment regression time, total duration of motor and sensory blockade, time for first rescue analgesia, hemodynamic changes and side effects were recorded. Results: The patients in group C had significantly prolonged sensory and motor blockade and less and delayed requirement of rescue analgesic than in group F. Conclusion: Intrathecal clonidine as adjuvant is better than fentanyl as it prolongs motor and sensory block and reduced demand of rescue analgesic.

A study to evaluate the effect of low dose Intrathecal dexmedetomidine as adjuvant to low dose bupivacaine (H) Spinal Anaesthesia in elderly patients undergoing Infraumbilical Surgery

Background: Elderly patients pose a serious challenge to anaesthesia not only because of associated co-morbidities but also due to physiological changes during aging. Therefore lower doses of local anesthetics along with Intrathecal a2-adrenoceptor agonists have been shown to decrease the required doses of local anesthetics and are devoid of major side effects. Hence this study evaluates spinal anaesthesia characteristics in elderly patients. Methods: 120 Patients aged more than 60 years belonging to ASA I,II and III physical status and posted for infraumbilical surgeries were randomized into 2 groups, Group B(Bupivacaine) and Group BD (Bupivacaine + Dexmedetomidine) .Under aseptic conditions lumbar puncture was performed in sitting position at L3-4 / L4-5 interspace and 2.1 ml of study agents were administered. Group B received 10mg of 0.5% hyperbaric Bupivacaine and Group BD received 10mg of 0.5% hyperbaric Bupivacaine and 5mcg of Dexmedetomidine. In all cases monitoring of Blood pressure, ECG, Oxygen saturation and Respiratory rate was done at regular intervals intra-operatively. Sensory block and motor blocks were assessed periodically. Results: There were no clinically and statistically significant changes in heart rate and blood pressure and the mean max fall in HR, SBP, DBP and MAP. However, it was observed that there was a statistically significant (P<0.001) decrease in the time of onset of sensory block and motor block in Group BD(1.68±0.96 and 2.42±1.12) when compared to Group B(2.24±0.81 and 3.33±1.06) . Duration of analgesia and the time for first rescue analgesia was prolonged in Group BD (P<0.001). There were no side effects except for mild sedation in Group BD. Conclusion: Addition of Dexmedetomidine 5 mcg to intrathecal Bupivacaine(H) in elderly patients causes minimum hemodynamic changes, prolongs sensory and motor block.

To study the efficacy of intravenous infusion of magnesium sulfate in the Indian population during epidural anesthesia using 0.5% bupivacaine for postoperative pain in infra-umbilical surgery

To study the efficacy of intravenous infusion of magnesium sulfate in the Indian population during epidural anesthesia using 0.5% bupivacaine for postoperative pain in infra-umbilical surgery

Comparative evaluation of fentanyl and dexamethasone as an adjuvant to bupivacaine for caudal analgesia in children undergoing infra-umbilical surgery

Comparative evaluation of fentanyl and dexamethasone as an adjuvant to bupivacaine for caudal analgesia in children undergoing infra-umbilical surgery

Analgesic Efficacy and Safety of Dexmedetomidine as an Adjuvant to Caudal Levobupivacaine for Infraumbilical Surgeries in Children

Analgesic Efficacy and Safety of Dexmedetomidine as an Adjuvant to Caudal Levobupivacaine for Infraumbilical Surgeries in Children

Role and efficacy of intrathecal bupivacaine (0.5) with the multiple doses of midazolam (1 mg to 2 mg) while lower limb surgeries

Background: Spinal anaesthesia, which is one of the techniques for infraumbilical surgeries, is most commonly criticized for limited duration of postoperative analgesia. Discovery of spinal receptors like alpha 2 adrenergic, cholinergic, opioid, NMDA and gamma aminobutyric acid (GABA) and benzodiazepine receptors trigger the use of drugs like neostigmine, clonidine, opioids ketamine, midazolam for their synergistic effect with intrathecal local Anaesthetics. Materials and methods: It was a double blind, prospective, randomised study patients with ASA 1 and 2 was taken. Exclusion criteria were patients with cardiac problem, respiratory problem, coagulation disorders, mental disorders and contraindication to regional block. Day before surgery preanesthetic evaluation was carried and procedure was explain to each patient. 0.5 mg alprazolam and ranitidine 150 mg given bedtime the night before surgery patient is kept NPO overnight. Results: In our study duration of motor block in group 1 and group 2 was 3.22 (hr) ± 0.73 & 3.52±0.77 P value 0.226. Duration of sensory block in group 1 and group 2 was 4.09 (hr) ± 0.88 & 6.69 (hr) ± 1.29 p-value<0.001 significant. There is higher duration of pain free period with group 2. So we can say that intrathecal 2mg Midazo lam added to bupivacaine, duration of postoperative analgesia was significantly prolonged than 1 mg midazolam. Conclusion: The duration of effective analgesia when midazolam is added to intrathecal bupivacaine is significantly prolonged thereby proving that midazolam is a useful adjunct to intrathecal bupivacaine for post-operative analgesia. Effect of intrathecal midazolam is dose dependent 2mg midazolam prolongs the action of bupivacaine with good sedation and no unwanted side effects.

Effects of addition of fentanyl and midazolam to local anaesthetic in lumbar epidural anaesthesia for infraumbilical surgeries

Introduction: Compared to general anaesthesia, regional anaesthetic techniques are more preferred in lower limb and lower abdominal surgeries as they have many advantages. Fentanyl a short acting opioid agonist, acts at µ receptor which is hundred times more potent than morphine. Fentanyl has many advantages compared to morphine because of its rapid onset of action and superior intra operative analgesia. Midazolam has an analgesic action by its action on the benzodiazepine GABA A receptor. Aim: The primary aim of the study was to compare the effect of two adjuncts to 0.5% bupivacaine through epidural anaesthesia. The study was directed towards the patients posted for infra umbilical surgeries. Materials and Methods: This study is conducted at Rajah Muthiah Medical College Hospital from august 2015- march 2016. Fifty patients posted for elective infra umbilical surgeries were divided into groups of 25 each. Group F received 18ml of 0.5% bupivacaine with 2 ml containing 100µg fentanyl and group M received 18ml of 0.5% bupivacaine with 2 ml of 2mg midazolam. Results: Both the groups maintained haemodynamic stability. Onset of sensory block was faster in group F (6.40 min) compared to group M (10.00min) which was statistically significant. The two segment regression time was found to be 150.8 min in group F compared to 147 min in group M. The mean duration of postoperative analgesia was significantly prolonged in group F (293.20min) when compared to group M (224.60min) with significant P value (0.05) Conclusion: Patients of fentanyl group exhibited prolonged duration of analgesia in comparison to midazolam group. Therefore fentanyl is more suited to midazolam in providing prolonged postoperative analgesia. Epidural fentanyl also produced faster onset of sensory blockade. There were no significant haemodynamic changes in both the groups. The occurance of nausea and vomiting was managed with a single dose of antiemetic. Keywords: Epidural anaesthesia, Fentanyl, Midazol

A Study on Hemodynamic Changes in Dexamethasone 0.1 mg/kg When Combined with 0.15% Ropivacaine for Caudal Analgesia in Children

Introduction: The efficacy of dexamethasone in prolonging the effect of local anesthetic has not been extensively studied when compared to other adjuvants. So, in our study we evaluated the analgesic efficacy of caudally administered dexamethasone along with dilute concentration of local anesthetics in children undergoing infra umbilical surgeries. Methodology: 60 children between the age group 1–5 years of ASA-PS I and II posted for elective infraumbilical surgeries were randomly grouped into two equal groups using shuffled sealed opaque envelope technique. Pre anesthetic evaluation was done and informed consent was obtained from the parents after explaining about the procedure and the drugs being used.The two groups were Group R (control group) and Group D (study group). Group R received 1 ml/kg of 0.15% ropivacaine with normal saline (1ml) and Group D received 1 ml/kg of 0.15% ropivacaine with dexamethasone 0.1 mg/kg in saline to make a total volume 1ml in the caudal epidural space. Results: No significant variation was noticed in either of the groups with respect to heart rate. The p values at all the various time intervals was &gt;0.05. Conclusion: There is no difference which is statistically significant between the diastolic blood pressures of the two groups.

Comparative study of higher volume lower concentration and lower volume higher concentration levobupivacaine in paediatric caudal block for postoperative pain relief in infraumbilical day care surgeries: Randomized observer blinded study

One of the commonly used regional anaesthesia technique for postoperative pain relief in paediatric surgery is caudal block. By increasing the volume of local anaesthetics, a higher initial level of blockade might extend the analgesic duration. Our aim was to compare analgesic durations between higher volume lower concentration and lower volume higher concentration levobupivacaine administered to children undergoing infraumbilical day care surgery. Materials and Methods: After obtaining ethical clearance and informed consent from guardian we performed randomized, prospective, observer-blinded study. Sample size calculated was 24 in each group. Caudal block was performed after induction and securing airway with appropriate size LMA. Children aged 6months to 5yr ASA I-II, received Levobupivacaine either 0.8 mL/kg of 0.375% (lower volume/ higher concentration [Group L], n 24) or 1.5 mL/kg of 0.1% solution (higher volume/ lower concentration [Group H], n 24) with radioopaque dye. Duration of analgesia and time for the 1st dose of oral acetaminophen was noted. Results: Fluoroscopic examination showed the spread levels of Levobupivacaine to T12(T12–L2) in Group L and T6 (T4–T8) in Group H. The mean duration of analgesia in Group H was significant than in Group L, i.e., 639.091 ± 89.8628 min and 587.028 ± 87.7387 (P Conclusions: Caudal analgesia with higher volume lower concentration of levobupivacaine (0.1%) provides longer duration of analgesia than lower volume higher concentration levobupivacaine (0.375%) in children undergoing day-care infraumbilical surgery. Keywords: Paediatric, caudal, Post operative analgesia, Levobupivacaine, Epidurography.

English

BACKGROUND We wanted to compare the efficacy of motor and sensory blockade in lower limb and lower abdomen surgeries achieved by ropivacaine-fentanyl and bupivacainefentanyl combinations administered intrathecally. METHODS A prospective, randomized [block randomization], interventional, comparative study was conducted on 116 American Society of Anesthesiologists physical status I – II patients. They were randomly divided into two groups of 58 patients each, to receive either 3 mL of 15 mg of 0.5 % ropivacaine with 25 mcg fentanyl [group RF] or 3 mL of 15 mg of 0.5 % bupivacaine with 25 mcg fentanyl [group BF] intrathecally. Pinprick test and Bromage scale was used to assess sensory and motor blockade, respectively. RESULTS Time taken for motor regression in group RF is lesser than that taken in group BF. CONCLUSIONS Ropivacaine along with fentanyl is more advantageous in spinal anaesthesia for infraumbilical surgeries due to brief duration of motor blockade. KEYWORDS Bupivacaine, Fentanyl, Ropivacaine, Spinal Anaesthesia

Caudal block with rectal diclofenac and paracetamol for pediatrics infra umbilical surgery at a comprehensive specialized teaching hospital in Ethiopia

BackgroundCaudal block is a common regional technique performed for infra umbilical surgery in pediatrics. Its limited duration of analgesia remains a gap in routine clinical practice. This study aimed to assess the analgesic effectiveness of caudal block with rectal diclofenac or rectal paracetamol among pediatric patients who underwent infra umbilical surgery. MethodsA prospective cohort study was conducted on patients aged 1–10 years that underwent elective infra umbilical surgery. Patients were allocated into the Caudal block with rectal Diclofenac, Caudal block with rectal Paracetamol, and Caudal block alone groups based on a postoperative pain management plan. Analysis of variance was used for normally distributed data and the Kruskal Wallis H test was used for non-normally distributed. The Tukey for post hoc test was used to compare the difference between groups one with the others. Categorical data were analyzed by using Pearson Chi-squared or Fisher's exact test as appropriate. A p-value < 0.05 considered as statistically significant. ResultsThe postoperative median pain score was lower in CD compared to CP and CA group (p-value < 0.001) at the 4th and 8th hour. Time to first analgesic request was significantly longer within CD 735 (540–1200 min) compared to CP 445 (240–840 min p = 0.029) and CA 315 (240–720 min p < 0.001). ConclusionThe pain score and total postoperative analgesic consumption were significantly reduced in addition to prolonged-time to request the first analgesia in the CD group compared to CA and CP group.

Case Report: The Combined Spinal and Caudal (CSC) Anesthetic-Is this the New Ideal Anesthetic in a Formerly Preterm, High-Risk Infant with Chronic Lung Disease Undergoing Infraumbilical Surgery?

Postoperative apnea is a well-recognized clinical entity commonly occurring in formerly preterm, high-risk infants. Spinal anesthesia has been demonstrated to be an attractive alternative to general anesthesia as it is associated with reduction of early risk of postoperative apnea in infants, hence it has become a valuable anesthetic technique in infraumbilical and lower extremity procedures, including inguinal herniorrhaphy.

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English

Comparing the efficacy and haemodynamic response between intrathecal hyperbaric 0.5% bupivacaine with isobaric 0.75% ropivacaine using fentanyl as adjuvant in patients undergoing infra umbilical surgeries

Central neuraxial blockade is the most widely used form of regional anesthesia in surgeries involving abdominal, urological, obstetric, gynaecological and lower limb. The nerve blocking properties of the R and S-enantiomers were similar but that the S-enantiomer was less cardiotoxic. The aim of our study is to compare the efficacy and haemodynamic response between intrathecal hyperbaric 0.5% Bupivacaine with isobaric 0.75% Ropivacaine using Fentanyl as adjuvant in patients undergoing infra umbilical surgeries. 60 patients of age group between 25 – 65 years belonging to American Society of Anaesthesiologist (ASA) 1 and 2 posted for general surgical, urological, orthopaedic and gynaecological procedures involving lower abdominal surgeries under spinal anaesthesia divided into two groups of 30 each and randomly allocated to one of the two below mentioned groups: Bupivacaine group (Group B) n=30; Ropivacaine group (Group R) n=30 Chi-square test and Student’s ‘t’ test were used to analyse the results. The sensory block in Bupivacaine group B was significantly higher compared to Ropivacaine group R attaining statistical significance. The 3 minutes motor block, incidence of hypotension was denser and higher in Bupivacaine group compared with Ropivacaine group. Incidence of bradycardia was not significantly different between the two groups.Although the onset of motor blockade was denser in Bupivacaine group, the total duration of motor blockade was similar between the groups. We conclude from our study that 0.75% isobaric Ropivacaine produces similar duration of efficacy with stable haemodynamics, as compared with 0.5% hyperbaric Bupivacaine.

Original Article Comparative Study to Evaluate Intravenous Dexmedetomidine as Bolus Versus Infusion with Spinal Anaesthesia for Infra-Umbilical Surgeries

Original Article Comparative Study to Evaluate Intravenous Dexmedetomidine as Bolus Versus Infusion with Spinal Anaesthesia for Infra-Umbilical Surgeries

English

English

Comparison between Dexmedetomidine or Magnesium Sulfate as Adjuvants to Bupivacaine for Caudal Anesthesia in Pediatric Patients Undergoing Infraumbilical Surgeries

Background: Caudal epidural anesthesia is a common technique providing intra and postoperative analgesia in pediatric infraumbilical surgical procedures. Objectives: The aim of this study was to compare the effect of adding Dexmedetomidine or Magnesium Sulfate as an adjuvant to Bupivacaine for caudal anesthesia in pediatric infraumbilical surgeries. Patients and Methods: This randomized controlled prospective study was done at Sohag University Hospital on sixty pediatric patients with American Society of Anesthesiologists (ASA) Classes I or II or III, weighted up to 20 kg scheduled for infraumbilical surgeries using caudal block in the period between January 2019 and January 2020. The included subjects were divided into three groups, twenty patients each: Group C (control), Group D (Dexmedetomidine group) and Group M (Magnesium group). Results: In our study, the caudal block mainly used to relieve pain after Sevoflurane anesthesia with less incidence of emergence agitation. On comparing (Group D) and (Group M), Face, Legs, Activity, Cry, Consolability scale (FLACC) score was lower in (Group D: 0,1,1,2) than (Group M: 1,1,2,2) without significant difference at postoperative set times (30 minutes,1,2,3 hours), respectively. At the 6th hour postoperatively, (Group M) patients achieved higher FLACC scores (3) compared with (Group D) patients (2.5) with statistically significant difference with P value of 0.05. During the first 3 hours post-operative, there were higher sedation scores in (Group D: 4,4,3,3) and (Group M: 4,4,3,2.5) more than (Control group: 3,2.5,2,2) with highly statistical significant difference with (P value < 0.001) at (30 minutes,1h, 2h, 3 hours), respectively. At the 6th hour postoperatively, there were higher sedation scores with (Group D) (3) more than (Group M) (2) with highly statistical significant difference with (P value < 0.001). Conclusion: Administration of Dexmedetomidine as adjuvant with Bupivacaine enhances caudal block, prolongs duration of postoperative analgesia, reduces postoperative EA and provides preferred postoperative sedation in pediatric patient undergoing infraumbilical surgeries with minimum adverse effects compared to Magnesium Sulfate as adjuvant.