Intensity Of Motor Block Research Articles

A Comparative Study of Epidural 0.75% Ropivacaine with Dexmedetomidine and 0.75% Ropivacaine Alone in Infra Umbilical Surgeries

Background: Different adjuvants are currently being employed alongside local anesthetics to extend the duration of pain relief during and after epidural block procedures for infra-umbilical surgeries. Dexmedetomidine is a recently popular neuroaxial adjuvant that acts as an extremely specific α2 adrenergic agonist. The purpose of this research is to evaluate and contrast the impacts of combining epidural giving of 0.75% ropivacaine with dexmedetomidine to the effects of using 0.75% ropivacaine alone. The focus was on evaluating the cardiovascular, sedative with analgesics potentiating The facets of these treatments.Methods: The research was randomized and studied in a double-blind, prospective fashion. It comprised 50 patients from the The individuals included in this study were classified as undertaking lower limb procedures were those who met the following criteria: Female, the age from 20 to 65, and holding American Society of Anesthesiologists Grades I and II. Informed agreement was given before the start of the study. Randomly, participants were divided into two groups, each consisting of 25 individuals. A 15 mL ropivacaine solution containing 0.75% was utilized to administrate epidural anesthesia to a group I (n = 25). In contrast, group II (n = 25) received the same 15 mL ropivacaine solution supplemented with 0.6 μg/kg of dexmedetomidine. The study compared two groups in terms of their hemodynamic changes and block characteristics. These characteristics included the time it took for analgesia to start at T10, the peak level of sensory perception analgesia achieved, the time it took for the sensory and motor block to reach their maximum levels, the time it took for the block to regress at the dermatome S1, and the time required to administer the initial quantity rescue effort analgesics to be administered within a 24-hour period.Results: Sedation score (p = 0.001), motor block intensity (p 0.001), and onset of action (p 0.001) were all significantly greater in the dexmedetomidine group. Additionally, motor block duration (p 0.001) was significantly longer. No significant differences were observed in the occurrence of maximal pain relief, low BP, or slow HR (p > 0.05), according to the study. There was a negligible and comparable occurrence of adverse effects (such as vertigo, tremor, and SpO2<90%) across all categories (p > 0.05). Conclusion: The research revealed noteworthy distinctions commencing with the inhibition of neural functions differs between the dexmedetomidine and ropivacaine groups, with dexmedetomidine producing more intense sustained motor block and sensory block. Both groups had greater sedation scores.

Prilocaine Fentanyl versus Bupivacaine-Fentanyl in Subarachnoid Anesthesia for Lower Abdominal Surgeries

Introduction and aim: Spinal anesthesia is a commonly and conveniently used for lower abdominal surgeries. The research on different drugs for spinal anesthesia is still ongoing to find out the standard and ideal drug. The current work aimed to compare efficacy and safety profile between prilocaine versus bupivacaine in spinal anesthesia for lower abdominal surgeries.
 Methodology: Ninety patients scheduled for elective lower abdominal surgeries were included and randomly assigned to one of two equal groups. All patients were preoperatively assessed by clinical and laboratory investigations. Hemodynamic monitoring was assessed intraoperatively every 5 minutes. Sensory and motor blockade and postoperative pain and time for first analgesic request were recorded. The primary outcomes were efficacy of block (onset of sensory block, onset and intensity of motor block and duration of action). The Secondary outcomes were hemodynamic changes, post-operative analgesia, and patient satisfaction.
 Results: The time for the onset of the highest sensory block was shorter among P than B group (5.91±1.84 vs 8.26±1.98 minutes, respectively). Similarly, the time for the onset of the highest motor block level and PACU length of stay (minutes) was significantly shorter among P than B groups. The postoperative pain score was reduced in P than B group. The time for first analgesic request was shorter among P than B group (192.44±11.21 vs 235.77±29.44 minutes). Sensory regression to L1 was shorter among P than B groups. The motor regarrisons at one hour showed significant difference. The postoperative systolic blood pressure was significantly reduced in B than P group, with increased hypotension in B than P group (17.8% vs 4.4%, respectively). On the other side, no significant difference was observed for other complications or satisfaction score.
 Conclusion: The combination of prilocaine and fentanyl is superior than bupivacaine and fentanyl for subarachnoid anesthesia in lower abdominal surgery.

Comparison of Analgesic Efficacy of Levobupivacaine and Levobupivacaine with Nalbuphine in Inguinal Hernia Surgeries Under Subarachnoid Block

Background: Recently there has been an interest to explore the efficacy of nalbuphine as' an adjuvant to local anaesthetic agents. This study was designed to compare its analgesic efficacy when added to levobupivacaine in patients undergoing inguinal hernia surgeries under subarachnoid block. Methods: Fifty patients belonging to ASA I/II, between 18-65 years of age undergoing inguinal hernia repair were randomly allocated to receive subarachnoid block with either 12.5 mg of 0.5% isobaric levobupivacaine (2.5 ml)+ normal saline (0.5 ml) (Group-LS) or 12.5 mg of 0.5% isobaric levobupivacaine (2.5 ml)+ 1 mg nalbuphine (0.1 ml) + normal saline (0.4 ml) (Group-LN). Onset of sensory block, two segment regression time, time of regression to T12, duration of effective analgesia and intensity of motor block were assessed. Results: Onset of sensory block was comparable in the two groups (P=0.774). Time of regression of sensory block to T12 dermatome was 161.09 ± 40.50 min in group LS and 167.50 ± 50.17 min in group LN (P=0.633).The duration of effective analgesia was 177.39 ± 43.53 min in group LS and 183.75 ± 56.69 min in group LN (P=0.669).Motor block parameters were also comparable.More number of patients in group LN had a sedation score of one as compared to group LS. No major side effects were seen. Conclusion: 12.5 mg levobupivacaine with or without nalbuphine is sufficient for conducting inguinal hernia surgeries. Intrathecal nalbuphine 1 mg did not affect the sensory and motor block characteristics of levobupivacaine.

The ultrasound-guided selective nerve block in the upper arm: an approach of retaining the motor function in elbow

BackgroundProximal brachial plexus blocks can lead to an extended period of motor paralysis and delay the return of motor function. This could influence patient satisfaction, and extend hospitalizations. The aim of the study is to compare a selective distal nerve block of the arm to a proximal axillary block, both ultrasound-guided, in terms of their motor block intensity of the elbow. Our hypothesis is that a selective nerve block of the arm would result in a different motor block of the elbow, compared to the axillary block.MethodsA sample size of 24 patients who were undergoing elective surgery (ASA I-III) of the wrist, hand or forearm was randomly divided into two groups: Arm Group (n = 12) and Axillary Group (n = 12). The Arm Group received ultrasound-guided block of the median, ulnar, and medial antebrachial cutaneous nerves at the level of upper-median 1/3 of the arm, and a block of the radial and musculocutaneous nerves at the level of low-median 1/3 of the arm, while the Axillary Group received ultrasound-guided axillary brachial plexus blocks. Both blocks used in combination with general anesthesia.ResultsOur results demonstrated that the incidence of motor block at the elbow in the Arm Group was lower than in the Axillary Group. Compared with the Axillary Group, the duration of motor block at the elbow and the onset time of sensory block in the Arm Group were shortened. The patient satisfaction was increased in the Arm Group. There were no differences in the duration of the sensory block, the effect on postoperative analgesia, or in the duration of the motor block at the shoulder between both groups.ConclusionOur study showed that ultrasound-guided selective nerve block in the upper arm allowed improved retention of motor function at the elbow compared to axillary block. Secondarily, the ultrasound-guided selective nerve block seemed to provide similar analgesia after surgery of the hand or forearm with an enhanced patient satisfaction.Trial registrationChinese Clinical Trial Registry, ChiCTR-IOR-16008769. Registered 3 July 2016.

Dexamethasone as an Adjuvant to Femoral Nerve Block in Children and Adolescents Undergoing Knee Arthroscopy: A Prospective, Randomized, Double-Blind, Placebo-Controlled Trial.

Perineural dexamethasone has been demonstrated to extend postsurgical analgesia after peripheral nerve blockade in adults. The mechanism of action of dexamethasone as a regional anesthetic adjuvant is unclear as intravenous dexamethasone has been shown to have similar analgesic efficacy as perineural dexamethasone. The efficacy of perineural dexamethasone has not been previously explored in the pediatric population. After obtaining informed consent, children (aged 10-18 years) presenting for arthroscopic knee surgery with a femoral nerve block were randomized to 1 of 3 groups: ropivacaine 0.5% and intramuscular saline (group R), ropivacaine 0.5% plus perineural dexamethasone 0.1 mg/kg (maximum 4 mg) and intramuscular saline (group D), and ropivacaine 0.5% and intramuscular dexamethasone 0.1 mg/kg (maximum 4 mg) (group M). The primary outcome was the number of doses of analgesic agents in the first 48 hours after hospital discharge. The number of doses was compared across study groups using Wilcoxon rank sum tests. Seventy-seven patients were enrolled in the study, of whom 4 were withdrawn because of additional surgical repair being performed, emergence delirium requiring unblinding, or loss to follow-up. The remaining 36 boys and 37 girls (aged 15 ± 2 years) included 23 patients randomized to group D, 23 patients randomized to group M, and 27 patients randomized to group R. The median number of pain medication doses within 48 hours of discharge was 2, 3, and 2 in groups D, M, and R, respectively. There were no significant differences in this outcome between groups D and M (difference in medians, 1; 95% confidence interval [CI] of difference in medians, -1 to 2; P = 0.475), groups D and R (difference in medians, 0; 95% CI of difference, -2 to 1; P = 0.821), or groups M and R (difference in medians, -1; 95% CI of difference, -2 to 1; P = 0.594). Other secondary outcomes, including time to first analgesic consumption after discharge, visual analog scale pain score, and subjective intensity of motor block, did not evince statistically significant differences among the study groups. In the pediatric population, perineural or intramuscular dexamethasone did not improve analgesia after femoral nerve blockade for knee arthroscopy. Whether the observed lack of benefit reflects a true adult-pediatric difference or a limitation of the study could not be determined. Future pediatric studies are needed to evaluate dexamethasone for other block types and other types of surgery. This study was registered at ClinicalTrials.gov, identifier NCT01971645.

Isobaric ropivacaine with or without dexmedetomidine for surgery of neck femur fracture under subarachnoid block.

Background and Aims:Dexmedetomidine has a promising role as an intrathecal adjuvant. However it's role as an adjuvant to ropivacaine has not been evaluated extensively. This study is designed to find out the effect of addition of dexmedetomidine 5 μg to isobaric ropivacaine 18.75 mg on block characteristics and hemodynamic parameters in patients undergoing surgeries for fracture neck of femur under subarachnoid block (SAB).Material and Methods:Sixty-one American Society of Anesthesiologists (ASA) Class I or II patients between 18–60 years undergoing surgeries for fracture neck of femur under SAB were recruited and randomized into two groups. Thirty patients in Group RN received 2.5 ml isobaric ropivacaine 0.75% (18.75 mg) with 0.5 ml normal saline (NS) to make a total volume of 3 ml, while 31 patients in Group RD received 2.5 ml isobaric ropivacaine 0.75% with dexmedetomidine 5 μg diluted with NS to make a total volume of 3 ml. The block characteristics, hemodynamic parameters, and side effects were recorded in both the groups.Results:Patients in Group RD had significantly longer duration of sensory block (202.90 ± 50.2 min) compared to Group RN (157.33 ± 31.6 min), P < 0.001. Time to first rescue analgesia request was significantly longer in the Group RD compared to Group RN (265.16 ± 71.4 min vs 203.67 ± 35.6 min, respectively) (P < 0.001). However, the sensory block onset, maximum block height, time to two dermatomal regression, and motor block intensity remained unaltered. Incidence of side effects like hypotension, bradycardia, nausea, vomiting, and shivering were statistically similar in both the groups.Conclusion:Addition of 5 μg dexmedetomidine enhances the analgesic effect of intrathecal 18.75 mg isobaric ropivacaine for the conduct of fracture neck of femur surgeries with minimal adverse events.

The Effect of Different Doses of Intrathecal Hyperbaric Bupivacaine Plus Sufentanil in Spinal Anesthesia for Cesarean Sections

BackgroundDecreasing side effects and improving the quality of block in caesarean sections by appropriate dosage of local anesthetics and adjuvants could play an important role in the safe management of cesarean section. The present study aimed at comparing the effects of 3 different doses of intrathecal hyperbaric bupivacaine injected with a fixed dose of sufentanil in cesarean sections.MethodsIn a double- blind randomized clinical trial, 105 candidates of elective cesarean section were randomly assigned into 3 groups of 8, 9, and 10 mg of intrathecal bupivacaine plus sufentanil 2.5 µg. The maximum level of sensory block, the intensity of motor block, and vital signs were measured at regular intervals. The incidence of hypotension and bradycardia were also recorded.ResultsNo significant difference was found between the maximum level of sensory block and the intensity of motor block in 3 groups. The incidences of hypotension and bradycardia as well as administration of atropine and ephedrine were comparable among the 3 groups (P > 0.05).ConclusionsAccording to similar effects of different doses of bupivacaine, administration of lower doses of bupivacaine (8mg) is more reasonable for spinal anesthesia for cesarean section.

The impact of magnesium sulfate as adjuvant to intrathecal bupivacaine on intra-operative surgeon satisfaction and postoperative analgesia during laparoscopic gynecological surgery: randomized clinical study.

BackgroundSurgeon satisfaction and patient analgesia during the procedure of laparoscopic surgery are important issues. The aim of this work was to study if an intrathecal (IT) Bupivacaine combined with Magnesium sulfate may or may not provide good surgeon satisfaction in addition to improvement of intraoperative and postoperative analgesia.MethodsSixty female patients were enrolled in this prospective, randomized, double-blind controlled clinical trial study. All patients were operated for gynecological laparoscopic surgery under spinal anesthesia. Patients were divided into two groups (Bupivacaine and Magnesium). Group Bupivacaine (30 patients) received intrathecal Bupivacaine 0.5% only (15 mg), while 30 patients in group Magnesium received intrathecal Bupivacaine (15 mg) in addition to intrathecal Magnesium sulfate (50 mg). The sensory block level, the intensity of motor block, the surgeon satisfaction, the intraoperative visual analog scale (VAS) for pain assessment, the postoperative VAS, and side effects were recorded during the intraoperative period and within the first 24 hours after surgery in the post-anesthesia care unit.ResultsSurgeon satisfaction, intraoperative shoulder pain, postoperative pain after 2 h, and perioperative analgesic consumption (ketorolac) were significant better in group Magnesium than in group Bupivacaine. (P < 0.05). The onset of motor and sensory blocks was significant longer in group Magnesium than the other one. The incidence of PONV, pruritus and urinary retention was insignificant statistically between both groups.ConclusionsMagnesium sulfate if used intrathecally as an adjuvant to Bupivacaine would provide a better surgeon satisfaction and would improve the analgesic effect of spinal anesthesia used for gynecological laparoscopic surgery.

A Comparative Evaluation of Intrathecal Levobupivacaine with Dexmedetomidine versus Levobupivacaine in Gynecological Surgeries.

Pain is the most distressing aspect of any type of surgery. Analgesic multimodalities have been used but are fragile with side effects that limit their usefulness. In this prospective randomized double blind study we have evaluated the anesthetic efficacy and safety of addition of 5 µgm dexmedetomidine to 15mg isobaric levobupivacaine in patients undergoing elective gynecological surgeries regarding time of onset, level of sensory block, intensity of motor block, duration of analgesia, haemodynamic stability and any complications. Eighty ASA I & II female patients, 30-60 yrs age scheduled for elective gynecological surgery under spinal anesthesia were divided into two groups. Patients were randomly allocated to receive either 3 ml isobaric levobupivacaine 5 mg/ml( 15mg) with 5 µgm dexmedetomidine ( group D, n=40) , or 3ml isobaric levobupivacaine 5mg/ml(15mg) with 0.5 ml normal saline(group S, n=40) .Time of onset m Levobupivacaine,Dexmedetomidinel,Regional anesthesia,Anesthetics techniques.

Dexmedetomidine versus clonidine as an adjunct to intrathecal small dose ropivacaine in patients undergoing transurethral resection of prostate

Context It is important to limit the cephalad spread of local anesthetic above T10 dermatome during spinal anesthesia in patients undergoing transurethral resection of prostate (TURP). This can be achieved by using small dose of local anesthetics in combination with intrathecal additives such as α 2 -agonists, which improve the quality of block without altering the height of block. Aims The aim of the study was to compare dexmedetomidine and clonidine when added to intrathecal ropivacaine in patients undergoing TURP. Settings and design The study was designed as a prospective, randomized, and double-blind study. Materials and methods Fifty patients of ASA grade I-III, scheduled for elective TURP, were allocated into two groups. Group I received 7.5 mg ropivacaine+15 μg clonidine and group II received 7.5 mg ropivacaine+5 μg dexmedetomidine. Spinal anesthesia was administered in the sitting position after preloading the patients with 10 ml/kg Ringer's lactate. Onset, duration, and peak sensory level, intensity of motor block, and analgesic requirements were recorded. Results Patients in both groups had comparable baseline and demographic characteristics. Peak sensory block was similar in both groups. Patients in group II had faster onset and longer duration of sensory block. Intensity and duration of motor block were also greater in group II. The quality of intraoperative and postoperative analgesia was better in group II. Conclusion Intrathecal dexmedetomidine with ropivacaine provides faster onset, better operating conditions, and patient comfort in patients undergoing TURP. However, it is associated with delayed motor recovery.

Epidural anesthesia and post-operative analgesia for bilateral inguinal mesh hernioplasty

Objectives:Ropivacaine is a long-acting amide local anesthetic, which is structurally very similar to bupivacaine but produces less motor block and less cardiac and central nervous system toxicity. It is also about 40% less potent than bupivacaine. Our double blind study was designed to compare the clinical efficacy of the equipotent doses of ropivacaine 0.75% and bupivacaine 0.5% for epidural anesthesia and ropivacaine 0.2% and bupivacaine 0.125% for post-operative analgesia in patients undergoing bilateral mesh hernioplasty.Methods:Sixty-one patients were randomized to receive 15 ml of 0.75% ropivacaine or 0.5% bupivacaine. Sensory and motor block characteristics were compared. Changes in heart rate, mean arterial blood pressure, and adverse effects were noted. For post-operative analgesia, 0.2% ropivacaine and 0.125% bupivacaine were given as continuous epidural infusion. Analgesia using VAS scores, motor block, volume of local anesthetic used and patient satisfaction was assessed.Results:There was no significant variation in the sensory block profile. A greater intensity of motor block was achieved with bupivacaine in the beginning but by 30 minutes the difference was not significant. Duration of motor block was similar in the two groups. Visual analog scale scores were similar in both groups during the post-operative period, with a similar motor block profile. No major side effects were noted in any group.Conclusion:The equipotent doses of ropivacaine and bupivacaine provided good quality epidural anesthesia and post-operative analgesia.

Continuous Interscalene Analgesia with Ropivacaine 0.2% Versus Ropivacaine 0.3% After Open Rotator Cuff Repair

Interscalene analgesia is a recognized technique for the management of postoperative pain after major shoulder surgery. The most effective local anesthetic concentration in this setting is still controversial. In this study, we compared the analgesia and side effects of a continuous infusion of ropivacaine 0.2% and 0.3% administered through an interscalene catheter for the first 48 hours after surgery. Eighty consecutive patients scheduled for elective open rotator cuff repair were randomized into 2 groups to receive a continuous infusion of either ropivacaine 0.2% or ropivacaine 0.3% for 48 hours at a rate of 14 mL/h through an interscalene catheter after a preoperative bolus of 40 mL ropivacaine 0.5% in all patients. Pain score (visual analog scale 0-100), intensity of motor block, quality of sleep during the first postoperative night, morphine consumption, side effects, and patient satisfaction were assessed by an anesthesiologist masked to treatment group. Total morphine consumption was significantly reduced in group 0.3% (12 vs 30 mg). Quality of sleep was significantly better in group 0.3% (4% vs 27% of awakening during the first postoperative night). Handgrip strength, visual analog scale scores, and side effects were similar in both groups. The use of ropivacaine 0.3% through an interscalene catheter for the first 48 hours after open rotator cuff repair provided a significant reduction of morphine consumption and a better sleep quality for the first postoperative night without increasing the intensity of motor block or side effects.

Vasodilatation médiée par sympathectomie: une étude randomisée de détermination de la concentration de bupivacaïne péridurale

We tested the hypothesis that the development of sympathectomy-mediated vasodilatation is dependent on the concentration rather than the dose of epidural local anesthetic administered. Sixty subjects receiving lumbar epidural bupivacaine were randomised to one of three groups: A: 10 ml 0.5% (50 mg); B: 10 ml 0.25% (25 mg); and C: 40 ml 0.0625% (25 mg). Groups A and B had equal volume but a twofold difference in drug dose, while groups B and C had equal drug dose, but a fourfold difference in drug volume. At baseline and 5, 10, and 20 min following epidural bupivacaine administration, we assessed the following indices of sympathectomy: pulse oximeter perfusion index in the toe and finger, skin temperature in the toe and finger, and mean arterial pressure. We also assessed sensory level (pinprick, cold, and light touch) and motor block. There was an increase in the pulse oximeter perfusion index by 20 min of 280%, 303%, and 59% in groups A, B, and, C, respectively. There was a significant sympathectomy-mediated vasodilatation in the toe for both groups A (P = 0.002) and B (P < 0.001) but not C (P = 0.22). Vasoconstriction in the finger was observed in group A only (P = 0.015) but not in group B (P = 0.09) or group C (P = 0.20). There were similar blood pressure changes and similar sensory changes in all groups. The intensity of motor block increased with increasing drug concentration. Our observations suggest that drug concentration is more important than drug dose in determining the degree of sympathectomy following lumbar epidural local anesthesia.

Effects on mother and fetus of epidural and combined spinal-epidural techniques for labor analgesia

Epidural (EA) and combined spinal-epidural (CSE) techniques have both been utilized for labor analgesia. This study compared the effects on the mother and newborn of these techniques in labor analgesia and anesthesia. Forty pregnant women received epidural analgesia with 15 mL of 0.125% ropivacaine (EA group) and 5 microg of sufentanil plus 2.5mg bupivacaine in the subarachnoid space (CSE group). Pain intensity, sensory blockade level, latency time, motor block intensity, labor analgesia duration, epidural analgesia duration, maternal hypotension, and pruritus were evaluated. The newborns were evaluated by Apgar and the neurological and adaptive capacity score (NACS) developed by Amiel-Tison. There were no significant statistical differences between groups for pain scores, latency time, sensory blockade level, and Apgar score. Motor block, labor analgesia duration, and epidural analgesia duration were greater in the CSE group, whose seven mothers had mild pruritus. The NACS were greater in the EA group after half, two, and 24 hours. Ninety five percent of EA group newborns and 60% of CSE group newborns were found to be neurologically healthy at the 24 hour examination. EA and CSE analgesia relieved maternal pain during obstetric analgesia, but CSE mothers had pruritus and a longer labor. Newborns of mothers who received epidural analgesia showed the best NACS.

Efeito sinérgico entre a dexmedetomidina e a ropivacaína 0,75% na anestesia peridural

This study aimed to evaluate clinical characteristics of epidural anesthesia performed with 0.75% ropivacaine associated with dexmedetomidine. Forty patients scheduled for hernia repair or varicose vein surgeries under epidural anesthesia participated in this study. They were assigned to: Control Group (n = 20), 0.75% ropivacaine, 20 ml (150 mg); and Dexmedetomidine Group (n = 20), 0.75% ropivacaine, 20 ml (150 mg), plus dexmedetomidine, 1 mg x kg-1. The following variables were studied: total analgesic block onset time, upper level of analgesia, analgesic and motor block duration time, intensity of motor block, state of consciousness, hemodynamics, postoperative analgesia and incidence of side-effects. Epidural dexmedetomidine did not affect onset time or upper level of anesthesia (p > 0.05) however it prolonged sensory and motor block duration time (p < 0.05) and postoperative analgesia (p < 0.05), and also resulted in a more intense motor block, l (p < 0.05). Values of bispectral index were lower in Dexmedetomidine Group (p < 0.05). There was no difference in incidence of hypotension and bradycardia (p > 0.05). Occurrence of side-effects (shivering, vomiting and SpO2 < 90%) was low and similar between groups (p > 0.05). There is clear synergism between epidural dexmedetomidine and ropivacaine, further this drug association does not bring about additional morbidity.

Efficacy of Ropivacaine, Bupivacaine, and Levobupivacaine for Labor Epidural Analgesia

Abstract Study Objective To compare analgesic efficacy and intensity of motor block with continuous infusions of ropivacaine, bupivacaine, and levobupivacaine in combination with fentanyl for labor epidural analgesia. Design Prospective, randomized, double-blinded study. Setting Labor and delivery suite at Magee Womens Hospital, Pittsburgh, PA. Patients 162 ASA physical status I and II, full-term, primiparous women. Interventions All patients received epidural labor analgesia. Epidural medication consisted of an initial bolus of 8 mL local anesthetic with fentanyl (100 μ g) followed by an infusion at 12 mL/h of local anesthetic with 2 μ g/mL fentanyl. Patients were allocated to one of three groups, as follows: group 1 received bolus and infusion of bupivacaine 0.125%, group 2 received bolus and infusion of levobupivacaine 0.125%, and group 3 received a bolus of ropivacaine 0.2% and infusion of ropivacaine 0.1%. Measurements Maternal vital signs, pain visual analog scale (VAS) score, sensory levels, and motor block (Bromage score) were recorded every hour. Duration of first and second stage of labor and mode of delivery were also recorded. Results There were no statistically significant differences in pain VAS or Bromage motor scores among the three groups of patients at any of the measured time intervals. The time to achieve T10 sensory level and patient comfort was shorter in the ropivacaine (9.35 ± 4.96 min) and levobupivacaine (9.56 ± 4.71 min) groups than the bupivacaine (11.89 ± 7.76 min) group, although this difference did not reach a statistically significant level ( P = 0.06). The second stage was significantly shorter in the bupivacaine group, lasting 81.27 ± 63.3 min, compared with the ropivacaine group (121.69 ± 86.5 min) and the levobupivacaine (115.5 ± 83.6 minutes) group ( P = 0.04). Conclusion There are no significant differences in pain VAS and Bromage scores between 0.1% ropivacaine, 0.125% bupivacaine, and 0.1% levobupivacaine given for labor epidural analgesia.

Labor analgesia with ropivacaine added to clonidine: a randomized clinical trial.

Previous studies have led to speculation that the association between ropivacaine and clonidine might be more effective than ropivacaine alone. We examined the maternal-fetal effects of two pharmacological approaches: a low dose of ropivacaine or a lower dose of ropivacaine plus clonidine for epidural analgesia during labor. Prospective study at Department of Anesthesiology, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista. Thirty-two pregnant women in American Society of Anesthesiologists physical status I and II randomly underwent epidural analgesia using 15 ml of ropivacaine 0.125% (R group) or 15 ml of ropivacaine 0.0625% plus 75 microg clonidine (RC group). Pain intensity, sensory block level, latency time, motor block intensity, duration of labor analgesia and duration of epidural analgesia were evaluated. The newborns were evaluated using Apgar scores and the Amiel-Tison method (neurological and adaptive capacity score). There were no statistically significant differences between the groups regarding pain score, sensory block level, duration of epidural analgesia or Apgar score. The latency time, duration of labor analgesia and motor block were R group < RC group. The half-hour and two-hour neurological and adaptive capacity scores were higher in the R group. All of the R group newborns and 75% of the RC group newborns were found to be neurologically healthy at the 24-hour examination. There were no statistically significant differences between the groups regarding pain score, sensory block level, duration of epidural analgesia or Apgar score. The latency time, duration of labor analgesia and motor block were R group < RC group. The half-hour and two-hour neurological and adaptive capacity scores were higher in the R group. All of the R group newborns and 75% of the RC group newborns were found to be neurologically healthy at the 24-hour examination. Both low-dose ropivacaine and a lower dose plus clonidine relieved maternal pain during obstetric labor. Newborns of mothers who received only ropivacaine showed better neurological and adaptive capacity scores.

Small dose spinal bupivacaine for Cesarean delivery does not reduce hypotension but accelerates motor recovery

Maternal hypotension occurs in 60-94% of Cesarean deliveries with 10-15 mg spinal bupivacaine. Reduced doses of bupivacaine may decrease the incidence of hypotension, nausea, and vasopressor use. The primary objective of this study was to compare 4.5 mg and 12 mg doses of intrathecal bupivacaine on maternal hemodynamics. The secondary objective was to determine if anticipated reductions in side effects were reflected in increased patient satisfaction. Following Research Ethics Board approval and informed consent 52 term parturients undergoing elective Cesarean delivery were randomly assigned to isobaric bupivacaine 4.5 mg or hyperbaric bupivacaine 12 mg for spinal anesthesia. All patients received fentanyl 50 microg and morphine 200 microg intrathecally. Intravenous fluid and vasopressor administration were standardized. Maternal hemodynamics, and sensorimotor levels were recorded at regular intervals. Side effects and patient satisfaction were documented. Median cepahalad sensory block was C8 in both groups (NS) but the intensity of motor block was significantly less (P < 0.001) and of shorter duration (P < 0.001) with bupivacaine 4.5 mg. The proportion of patients requiring ephedrine (> 70%) and the quantities of ephedrine used were similar in both groups (NS). Use of supplemental analgesia, side effects, and measures of patient satisfaction were comparable in both groups. Intrathecal bupivacaine 4.5 and 12 mg yielded similar sensory block and side effects during Cesarean delivery. Patients receiving 4.5 mg did, however, experience significantly less motor blockade of shorter duration.

Efficacy of ropivacaine, bupivacaine, and levobupivacaine for labor epidural analgesia

Study Objective To compare analgesic efficacy and intensity of motor block with continuous infusions of ropivacaine, bupivacaine, and levobupivacaine in combination with fentanyl for labor epidural analgesia. Design Prospective, randomized, double-blinded study. Setting Labor and delivery suite at Magee Womens Hospital, Pittsburgh, PA. Patients 162 ASA physical status I and II, full-term, primiparous women. Interventions All patients received epidural labor analgesia. Epidural medication consisted of an initial bolus of 8 mL local anesthetic with fentanyl (100 μg) followed by an infusion at 12 mL/h of local anesthetic with 2 μg/mL fentanyl. Patients were allocated to one of three groups, as follows: group 1 received bolus and infusion of bupivacaine 0.125%, group 2 received bolus and infusion of levobupivacaine 0.125%, and group 3 received a bolus of ropivacaine 0.2% and infusion of ropivacaine 0.1%. Measurements Maternal vital signs, pain visual analog scale (VAS) score, sensory levels, and motor block (Bromage score) were recorded every hour. Duration of first and second stage of labor and mode of delivery were also recorded. Results There were no statistically significant differences in pain VAS or Bromage motor scores among the three groups of patients at any of the measured time intervals. The time to achieve T10 sensory level and patient comfort was shorter in the ropivacaine (9.35 ± 4.96 min) and levobupivacaine (9.56 ± 4.71 min) groups than the bupivacaine (11.89 ± 7.76 min) group, although this difference did not reach a statistically significant level ( P = 0.06). The second stage was significantly shorter in the bupivacaine group, lasting 81.27 ± 63.3 min, compared with the ropivacaine group (121.69 ± 86.5 min) and the levobupivacaine (115.5 ± 83.6 minutes) group ( P = 0.04). Conclusion There are no significant differences in pain VAS and Bromage scores between 0.1% ropivacaine, 0.125% bupivacaine, and 0.1% levobupivacaine given for labor epidural analgesia.

The Analgesic Effect of Single Dose of Intrathecal Magnesium Sulfate

S7 2 Background: Intrathecal (IT) magnesium has antinociceptive effects on animals and has been reported to prolong spinal opioid analgesia in humans. This study examined the effect of IT magnesium on spinal anesthesia and postoperative epidural analgesia. Methods: Sixty patients undergoing total knee replacement were enrolled in this study. Before the IT injection of 0.5% isobaric tetracaine (10 mg), group C and group M received 0.9% saline or 50% magnesium sulfate 0.1 ml, respectively. The epidural solution for postoperative analgesia contained 0.2% ropivacaine (100 ml) only in group M, and 0.2% ropivacaine plus morphine (50μg/ml) in group C. The verbal rating scale (VRS) scores for pain, sensory block level, intensity of motor block and side effects were recorded at 5, 60, and 120 minutes after the IT injection and at 1, 12 and 36 hours after surgery in the post-anesthesia care unit (PACU). Results: The VRS score at 120 minutes after the IT injection were lower in group M than in group C (P ＜ 0.05). There were no differences in the VRS scores and the use of supplemental analgesics at the postoperative period. The incidence of PONV, pruritus and urinary retention was significantly lower in group M than in group C at 12 and 36 hours after surgery. Conclusions: IT magnesium can be used as a local anesthetic adjuvant to strengthen the analgesic effect of spinal local anesthesia and to intensify the analgesic effect of epidural local anesthesia for postoperative pain control to the extent of 5 mg epidural