Intrathecal Hyperbaric Bupivacaine Research Articles

The Median Effective Dose of Intrathecal Hyperbaric Bupivacaine for Cesarean Section at Moderately High-Altitude.

Alterations in altitude can lead to an augmented requirement for local anesthesia among patients. Nevertheless, the necessity for an elevated dosage of local anesthetic for parturients at moderately high altitudes during spinal anesthesia for cesarean section remains uninvestigated. This up-down sequential study endeavors to determine the ED50 dose of bupivacaine required for spinal anesthesia during cesarean sections at moderately high-altitude. Thirty singleton parturients at moderately high altitude underwent elective cesarean section under combined spinal-epidural anesthesia. The up-and-down sequential method was employed, starting with an initial dose of 12mg (1.6mL) of 0.75% hyperbaric bupivacaine for the first participant. The dose for the next case was adjusted up or down by 0.75mg based on the effectiveness of the previous participant. Effectiveness was defined as the bilateral sensory block reaching T6 within 15 minutes after spinal anesthesia injection, without the need for additional epidural anesthesia before fetal delivery. The ED50 dose and 95% confidence interval were calculated using the Dixon sequential method and isotonic regression, respectively. The incidence of maternal hypotension, nausea, and vomiting during the study period was also recorded. The ED50 of hyperbaric bupivacaine for spinal anesthesia in cesarean section was calculated as 8.23 mg (95% CI, 6.52-9.32 mg) using the Dixon up-and-down method. Further validation using isotonic regression yielded a value of 8.39 mg (95% CI, 7.48-9.30 mg), confirming the accuracy and sensitivity of the conclusion. During the operation, only 6 parturients experienced hypotension, and no adverse reactions such as nausea, vomiting, and shivering were observed. The ED50 dose of 0.75% hyperbaric bupivacaine for spinal anesthesia during cesarean section at moderately high altitude is 8.23 mg, which exceeds the ED50 dose typically required by parturients at low altitude. Comprehensive investigations are warranted to ascertain the ED90 or ED95 dose of local anesthetics for cesarean section at moderately high altitudes, thereby offering enhanced guidance for clinical practice.

Minimum effective dose of intrathecal hyperbaric bupivacaine for cesarean section with and without prophylactic norepinephrine infusion: Randomized triple-blinded trial

Abstract Background and Aims: Vasopressor usage can affect the rostral spread of intrathecal drug and, hence, its requirement during cesarean delivery. Although a decreased spread is evidenced with phenylephrine, there is no data for norepinephrine usage. The present study aimed to evaluate the minimum effective dose of intrathecal hyperbaric bupivacaine for cesarean section with and without prophylactic norepinephrine infusion. Material and Methods: Patients scheduled for elective cesarean section under combined spinal–epidural block were randomized to receive intravenous infusion of norepinephrine (0.05 μg/kg/min) or normal saline (placebo), initiated immediately after intrathecal injection. Postspinal hypotension in either group (systolic arterial pressure ≤0.8 baseline) was treated with norepinephrine 4 μg rescue. Dose of intrathecal hyperbaric bupivacaine (0.5%) was decided for individual patients using up-and-down sequential allocation method. Primary outcome measure was the minimum effective dose of intrathecal hyperbaric bupivacaine (0.5%) defined as ED50, while secondary observations included spinal block characteristics and neonatal outcomes. Results: Demographic parameters were statistically similar between both groups (P > 0.05). ED50 of intrathecal hyperbaric bupivacaine was 7.8 mg (95% confidence interval [CI]: 6.7–8.8) and 7.4 mg (95% CI: 6.1–8.7) for normal saline and norepinephrine group respectively (P = 0.810). Block characteristics were similar between both groups as was neonatal APGAR score, but umbilical artery base excess was greater for norepinephrine versus normal saline group (−4.4 ± 3.6 vs. −6.5 ± 2.4, P = 0.038). Conclusion: Use of prophylactic norepinephrine (0.05 μg/kg/min) during cesarean delivery does not require adjustment of intrathecal hyperbaric bupivacaine.

Intrathecal midazolam is a comparable alternative to fentanyl and nalbuphine as adjuvant to bupivacaine in spinal anesthesia for elective Cesarean Section; a randomized controlled double-blind trial

Background: Different adjuvants have been introduced to enhance the quality of local anesthetics and reduce its adverse events. This study was directed to compare the anesthetic and analgesic properties of intrathecal hyperbaric bupivacaine when three different adjuvant drugs were added.
 Methodology: One hundred full-term parturients aged 18 to 40 years, scheduled for elective cesarean section, were randomly assigned to 4 groups. Each group received 12.5 mg of 0.5% hyperbaric bupivacaine combined with either 0.5 ml saline (Group-B), 25µg fentanyl (Group-F), 0.8 mg nalbuphine (Group-N) or 2 mg midazolam (Group-M). The outcomes included the postoperative effective analgesia time, the sensorimotor characteristics, postoperative VAS score, pethidine consumption, maternal complications, and neonatal Apgar score.
 Results: Earlier onset of sensory and motor block was observed in Group F and N than in Group B and M. Duration of postoperative effective analgesia was longer in Groups F, N and M (252.42 ± 46.11, 227.34 ± 36.54 and 243.71 ± 44.95 hours, respectively) than in Group B (172.11 ± 20.99) (P < 0.001). VAS scores decreased in adjuvant groups during the first 12 hours postoperative and required pethidine doses were less.
 Conclusion: Addition of adjuvant agents to intrathecal bupivacaine improved the quality of subarachnoid block without increasing side-effects. Intrathecal midazolam provided comparable outcomes as the frequently used opioids.
 Abbreviations: CS: Cesarean section; LA: Local anesthetics; SA: Spinal anesthesia
 Key words: Intrathecal; Nalbuphine; Midazolam; Fentanyl; Postoperative analgesia; Cesarean section.
 Citation: Amin SR, Souidan I, Abdelzaam EM. Intrathecal midazolam is a comparable alternative to fentanyl and nalbuphine as adjuvant to bupivacaine in spinal anesthesia for elective cesarean section: a randomized controlled double-blind trial. Anaesth. pain intensive care 2022;27(1):89−96; DOI: 10.35975/apic.v27i1.1923
 Received: June 26, 2022; Reviewed: November 28, 2022; Accepted: December 14, 2022

Evaluation of adding magnesium sulphate to intrathecal bupivacaine in lower limb orthopedic surgery

BackgroundA subarachnoid block is the cheaper and widely used regional block for lower limb surgery. Postoperative pain occurs after lower limb orthopedic surgery from moderate to severe. We conducted a prospective, randomized, double-blind controlled trial. All patients were assessed for onset and duration of sensory and motor block, total duration of analgesia, and postoperative pain relief.This study was conducted to evaluate the efficacy of intrathecal bupivacaine with magnesium undergoing lower limb orthopedic surgery.ResultsOne hundred patients were randomly divided into two equal groups. Group M: Intrathecal 3 ml (15 mg) of 0.5% bupivacaine + 0.2 ml (50 mg) of preservative-free 25% of magnesium sulphate. Group B: Intrathecal 3 ml (15 mg) of 0.5% bupivacaine + 0.2 ml preservative-free 0.9% normal saline. The mean time that occurred for the sensory blockade at T10 was 2.49 ± 0.49 min in group B, while it was 4.13 ± 0.74 min in group BM (p value < 0.0001). The mean of the total duration of the sensory block in group B was 139.5 ± 32.01 min, while it was 366.4 ± 30.12 min in group BM (p value < 0.0001). The time taken for the onset of motor block in group B was 5.28 ± 1.31 min, while it was 7.86 ± 1.19 min in group BM (p value < 0.0001). The mean total duration of the motor block in group B was 136.3 ± 8.19 min, while it was 336.5 ± 37.08 min in group BM (p value < 0.0001). The total duration of analgesia in group B was 141.4 ± 14.85 min, while it was 365.9 ± 44.91 min in group BM (p value < 0.0001). The mean dose required for rescue analgesia in group B was 2.2 ± 1.14, while in group BM was 1.28 ± 0.96 (p value < 0.0001).ConclusionsThe addition of 50 mg magnesium sulphate in intrathecal hyperbaric bupivacaine significantly prolongs the extended duration of sensory, motor blockade, and total duration of analgesia for patients undergoing lower limb orthopedic surgery.

Comparison of Nalbuphine Versus Clonidine as an Adjuvant to Intrathecal Hyperbaric Bupivacaine in Orthopedic Lower Limb Surgeries: A Randomized Controlled Double-Blind Study.

Nalbuphine and clonidine are used as adjuvants to intrathecal local anesthetics, but studies on their comparative efficacy have shown inconsistent results. This study aimed to compare nalbuphine, clonidine, or normal saline as adjuvants to intrathecal hyperbaric bupivacaine in orthopedic lower limb surgeries. Method: Sixty-threeAmerican Society of Anesthesiologists (ASA) I/II patients between 18 and 60 years old with lower limb fractures were randomized into three groups (n=21 each). Patients with contraindications to spinal block, bilateral lower limb fractures, or long-term opioid therapy were excluded. The subarachnoid block was given in L3-L4 interspace. Group N received 1 mg of nalbuphine, group Cl received 30 mcg of clonidine, and group C received 0.5 ml of normal saline with 15 mg (0.5%) of hyperbaric bupivacaine. Sensory and motor block characteristics, hemodynamic variables and side effects were noted, and the data were analyzed using Student's t-test, Mann-Whitney test, Chi-square test, and ANOVA followed by Tukey's test. Patients receiving intrathecal nalbuphine (group N) and clonidine (group Cl) had a faster onset of the sensory and motor block than controls (group C) (p=0.000). The time to two-segment regression was more prolonged in group Cl when compared to group N (p=0.000). Duration of spinal analgesia was 216.75 ± 25.96 minutes, 292.86 ± 24.92 minutes, and 178.50 ± 16.06 minutes in groups N, Cl, and C, respectively (p=0.000). The 24-hour rescue analgesic requirement was maximum in group C and least in group Cl (p=0.000). The three groups were comparable to each other in terms of side effects. Clonidine was found to be superior to nalbuphine as an intrathecal adjuvant with no significant side effects.

A comparison of intrathecal clonidine and buprenorphine as spinal anesthesia adjuvant for abdominal and lower limb surgeries

Background: Many intrathecal adjuvants are being used with local anesthetics to prolong the intraoperative anesthesia and postoperative analgesia. Clonidine and buprenorphine are known to potentiate the effects of local anesthestics. Aims and Objectives: This study was designed to compare the duration of postoperative analgesia as well as duration of sensory and motor block onset, intraoperative hemodynamic changes, and perioperative complications between buprenorphine and clonidine when used as an adjuvant to intrathecal hyperbaric bupivacaine. Materials and Methods: A randomized double-blind study for 80 patients undergoing lower abdominal surgeries and lower limb surgeries was designed with Group B receiving 50 mcg of buprenorphine and Group C receiving 50 mcg of clonidine with 15 mg of hyperbaric bupivacaine 0.5%. Student’s t-test and Chi-square were used for comparing the data. Results: The time of onset of duration of post-operative analgesia as well as sensory and motor block was significantly higher in buprenorphine group as compared to clonidine group. In present study, incidence of bradycardia as well as hypotension was significantly higher in group C as compared to group B (P&lt;0.05). Conclusion: Addition of intrathecal buprenorphine and clonidine potentiates the duration of analgesia, sensory and motor block, with buprenorphine has a longer analgesic effect when compared to clonidine.

Comparison of the onset and duration of analgesia with intrathecal hyperbaric bupivacaine and intrathecal hyperbaric bupivacaine plus midazolam for lower limb orthopaedic surgeries.

Background: Various additive drugs have been added to bupivacaine to modify its onset and duration of analgesia; these include among others the use of midazolam, tramadol, morphine and fentanyl. This study, therefore, was aimed at comparing the onset and duration of analgesia during intrathecal hyperbaric bupivacaine 0.5% alone and intrathecal hyperbaric bupivacaine 0.5% with midazolam for lower limb orthopaedic surgeries. Methodology: This was a prospective randomized double-blinded controlled study that recruited one hundred and thirty-eight (138) ASA I and II patients scheduled for elective lower limb orthopaedic surgeries. The patients were allocated into two groups. Group BA (n=69) received 12.5mg(2.5mls) of 0.5% hyperbaric bupivacaine with 0.5mls normal saline intrathecally at L3-L4 or L4-L5 inter-space, and group BM that received 12.5mg (2.5mls) of 0.5% hyperbaric bupivacaine with 2.5mg (0.5mls) of preservatives-free midazolam at L3-L4 or L4-L5 intrathecally, no premedicants were given. Standard monitoring of the vital signs was done. The onset and duration of analgesia were documented and analysed. Results: Results showed that the mean onset time of analgesia was 37.04±4.53min and 25.65±4.84min in groups BA and BM respectively, with statistically significant difference (P &lt; 0.01). While the mean duration of analgesia were151.43 ± 58.84 min and 323.4 ± 22.55 min in groups BA and BM respectively, P&lt;0.01. Conclusion: The addition of 2.5mg (0.5ml) of midazolam to hyperbaric bupivacaine for subarachnoid block shortens the onset and prolonged the duration of analgesia when compared to bupivacaine alone.

Comparison between Fractionated Dose versus Bolus Dose of Intrathecal Hyperbaric Bupivacaine Injection in Spinal Anesthesia for Patients Undergoing Elective Caesarean Section

Background: Spinal anesthesia (SA) with bolus dose has rapid onset but may causes hypotension. When we inject local anesthetic in fractions with a time gap, it provides more hemodynamic stability an. We aimed to compare fractionated dose with bolus dose in SA for hemodynamic stability in patients undergoing elective lower segment caesarean section (LSCS). Objectives: To find out whether the fractionated dose of spinal local anesthetics could reduce the incidence of hemodynamic changes in comparison to bolus dose of spinal local anesthetics. Methods: After clearance from the Institutional Ethics Committee, the study was carried out in 80 patients undergoing elective LSCS. Patients were divided into two groups. Group B patients received single bolus SA with injection bupivacaine heavy (0.5%) and Group F patients fractionated dose with 2/3rd of the total dose of injection bupivacaine heavy (0.5%) given initially followed by 1/3rd dose after 90 s. The intraoperative hemodynamics were recorded and analyzed with chi- square test Student’s t-test. Result: Intraoperative mean blood pressure of group –F were higher than those of Group-B patient and showed statistically significant difference. Mean heart rate of group –F were higher than those of Group-B patient and showed statistically significant difference. Conclusion: Fractionated dose of SA provides greater hemodynamic stability compared to bolus dose. J Shaheed Suhrawardy Med Coll 2021; 13(2): 150-157

A Comparative Study on the Effect of Intrathecal Bupivacaine vs. Ropivacaine on Maternal and Neonatal Outcomes After Cesarean Section: A Systematic Review and Meta-analysis.

The type of anesthesia in cesarean section can affect the mother and baby. This study aimed to determine the comparative effect of intrathecal hyperbaric bupivacaine vs. hyperbaric ropivacaine on maternal and neonatal outcomes after cesarean section. PubMed, Web of Science, Embase, Google Scholar, IranDoc, MagIran, and Scopus databases were searched from 1 September 2022 to 1 November 2022. Eighteen clinical trials with 1542 patients were included in the analysis. There was no statistically significant difference in hypotension, bradycardia, and Apgar score between the 2 groups (P > 0.05). The risk of nausea (relative risk (RR), 1.526; 95% CI, 1.175 - 1.981; P = 0.001) and vomiting (RR, 1.542; 95% CI, 1.048 - 2.268; P = 0.02) caused by bupivacaine was 0.53% and 0.54% higher than that of ropivacaine. The incidence of shivering (RR, 2.24; 95% CI, 1.480 - 3.39; P = 0.00) was 2.24 times higher in the bupivacaine group than in the ropivacaine group. The average onset time of sensory block (standardized mean difference (SMD), -0.550; 95% CI, -1.054 to -0.045; P = 0.032) and motor block (SMD, -0.812; 95% CI, -1.254 to -0.371; P = 0.000) was significantly lower in the bupivacaine group than in the ropivacaine group. Despite the fact that ropivacaine and bupivacaine are effective in cesarean section, ropivacaine is more favorable because of less hemodynamic changes, less duration of sensory and motor block, and fewer side effects, which are effective in patient recovery.

Effect of intra-abdominal pressure on maximum level of intrathecal sensory block: A preliminary randomized controlled trial

Objectives: Increase in Intra-Abdominal Pressure (IAP) is commonly accepted as a cause for intrathecal dose sparing and consequently higher level of sensory block during pregnancy. There is however very little actual data evaluating the relationship. Thus, we aimed to evaluate association between IAP and maximum level of sensory block following intrathecal injection of hyperbaric bupivacaine as well as plain levobupivacaine for cesarean section. Methods: Preliminary randomized controlled blinded trial included females aged 18-40 years, scheduled for elective cesarean section under single-shot subarachnoid block. After randomization, they received either intrathecal hyperbaric bupivacaine (group H) or plain (isobaric) levobupivacaine (group P) in a dose of 12.5 mg (n = 40 each). IAP was measured before and after the spinal block, using the recommended intravesical technique. The maximum level of sensory block and the IAPs were measured in each patient. Results: There was no significant correlation of IAPprespinal with maximum level of sensory block for group H (P = 0.334; rs = -0.157) or group P (P = 0.637; rs = -0.078). Similarly, there was no significant correlation of the IAPpostspinal: group H (P = 0.370; rs = -0.145); and group P (P = 0.714; rs = -0.061). Both group H and group P had similar IAPprespinal (15.9 [14.3-18.2] and 15.3 [14.3-17.4] mmHg, respectively) (P = 0.474); as well as IAPpostspinal (15.2 [13.8-17.2] and 14.6 [13.4-16.0] mmH, g respectively) (P = 0.239). Among ancillary observations, duration of sensory block was significantly longer for group P versus group H (133.6 ± 24.2 and 103 ± 23.4 mins; P < 0.000). However, the maximum levels of sensory and motor block, respective times required to achieve them, as well as incidences of intraoperative hypotension and bradycardia were statistically similar between group H and group P (P > 0.05). Conclusions: The IAP was raised to the level of conventionally defined intra-abdominal hypertension (>12 mmHg) in patients scheduled for elective cesarean section. However, despite being increased, the IAPprespinal or IAPpostspinal did not show any significant association with the maximum level of sensory block (P > 0.05).

Comparison of Bupivacaine (0.5%) and Bupivacaine (0.5%) with Dexmedetomide for Spinal Anesthesia in Lower Abdominal and Pelvic Surgery

Background: Dexmedetomiodine has also been used intrathecally to enhance the duration of motor and sensory blockade produced by hyperbaric bupivacaine. By increasing the dose of intrathecal dose of intrathecal dexmedetomidine it has been found that there is a significant increase in duration of motor and sensory blockade produced by intrathecal hyperbaric bupivacaine. Purpose of this study was to evaluate whether addition of dexmedetomidine changes the characteristics of bupivacaine 0.5% analgesia and other effects when injected intrathecally. Materials &amp; Methods: This prospective, double-blind, randomized, controlled study was conducted in 100 patients of ASA PS I-II, aged between 20-60 yrs, of either sex, scheduled for elective lower abdominal and pelvic surgery were chosen and divided into two groups. Patients were randomly allocated to receive intrathecally either 3ml of 0.5% hyperbaric bupivacaine plus 1ml normal saline (group X) or 3ml of 0.5% hyperbaric bupivacaine plus dexmedetomidine 4 µg in 1 ml (group Y). The time taken to achieve peak sensory (T10 dermatome) and motor blockade (Bromage score 3), duration of block, recovery characteristics and hemodynamic changes were recorded. Any adverse symptoms like nausea, vomiting, shivering, pruritis, and sedation etc were noted.Results: The mean time of sensory block to reach T10 dermatome was 5.56±1.23 minutes in Group Y, 6.48±1.18 minutes in Group X.The mean time to reach Bromage 3 scale was 8.94±1.62 minutes in Group Y and 11.88±1.42 minutes in Group X. The regression time to Bromage 0 was 291.7±30.2 minutes for Group Y and 144.8 ±10.5 minutes for Group X. Onset and regression of sensory and motor block were highly significant ( p&lt;0.0001). The mean time for 2 segment regression was 111.1±14.96 for group Y and 89.2±9.11 for group X (p&lt;0.0001).&#x0D; Conclusion: The onset of sensory and motor blockade was shortened by dose of dexmedetomidine. The duration of sensory and motor block was also prolonged. Therefore it can be concluded that dexmedetomidine has effect on sensory and motor block when used as an adjuvant to bupivacaine in spinal anaesthesia

Height-adjusted dose of intrathecal bupivacaine on surgical anesthesia for the cesarean section

Background: In the spinal anesthetic technique, local anesthetic dose (concentration and volume) is the main determinant of its adequacy and success of block to be achieved. The lack of pain during surgical intervention rather than on dermatome sensory block level is considered to be an appropriate indicator of surgical anesthesia. Spinal anesthesia is the most common anesthetic technique to provide anesthesia for the elective or emergent cesarean section (CS). However, spinal block-induced maternal hypotension is the most common adverse effect during single-shot spinal anesthesia. In our study, we aim to study the height-adjusted dose of 0.5% Bupivacaine Heavy (BH) in achieving surgical anesthesia and its effect on maternal hypotension. Participants and Method: One hundred parturients scheduled for elective CS were enrolled and were compared to the parallel arms of parturients receiving conventional BH. Fifty parturients in each group were included. In the conventional group (B), participants received spinal block with 12 mg of 0.5% BH, and in the height adjusted-dose group (H), participants received a dose of 0.5% BH in 0.06 mg per centimetre height. A sensory block level of T6 dermatome or higher was consider adequate to start surgery. The adequate surgical anesthesia is considered to be achieved if cesarean delivery can be performed without supplementary analgesia. The need of supplementary analgesia, conversion to general anesthesia, or no block till 15 min of intrathecal BH is considered spinal failure. Results: 4% of the height-adjusted dose group have a low block level. Two cases complained of pain, and of them, one received supplementary analgesia and one was converted to general anesthesia. Systolic hypotension of a maternal blood pressure of less than 90 mm Hg was found in 19 (38%) and 10 (20%) in the conventional group and HAD group, respectively, which was highly significant statistically (p value 0.001%). Conclusion: Intrathecal hyperbaric bupivacaine in height adjusted 0.06 mg per cm height of patient can achieve surgical anesthesia with maintainance of systolic blood pressure. However, low dosing of intrathecal BH has higher cases of block failure in comparison to the conventional fixed dose regime of spinal anesthesia.

Comparison of Analgesic Efficacy of Nalbuphine and Fentanyl as Adjuvants to Intrathecal Hyperbaric Bupivacaine in Patients undergoing Lower Limb Orthopaedic Surgeries: Randomised Clinical Trial

Introduction: Postoperative pain management poses a major challenge in patients who undergo lower limb orthopaedic surgeries. Methods that reduce the requirements of systemic analgesics and have minimal adverse effects on haemodynamic stability are the need of the hour. Nalbuphine, a kappa agonist/ partial μ antagonist can be utilised in spinal anaesthesia as an auxiliary to local anaesthetic. Aim: To evaluate the efficiency of intrathecal hyperbaric bupivacaine versus nalbuphine plus fentanyl as adjuvants in patients undergoing lower limb orthopaedic surgeries. Materials and Methods: This prospective randomised clinical trial comprised 70 American Society of Anaesthesiologists (ASA) grade I and II patients aged between 18 to 60 years who had been posted for elective lower limb orthopaedic operations. Patients were randomly assigned to either Group NB (intrathecal bupivacaine with nalbuphine) or Group FB (Intrathecal bupivacaine with fentanyl). Onset and duration of sensory and motor block, haemodynamic alterations, side-effects, and requirement for systemic analgesics in the postoperative period were examined. Results: There was no statistically significant difference in beginning of sensory and motor blockage between the two groups. In comparison to group FB, group NB’s sensory blockade lasted substantially longer (126.06±6.52 minutes vs. 103.34±3.7 minutes; p-value&lt;0.001). In group NB, the length of the motor block was considerably longer (p-value&lt;0.001). When compared to patients in group FB (230.83±7.98 minutes), patients in group NB experienced analgesia for a mean time of 278.31±9.58 minutes, which was noticeably longer. There was no discernible difference between group NB and group FB (p-value&gt;0.05) in terms of symptoms such as nausea, vomiting, bradycardia, and hypotension throughout the intraoperative period. Conclusion: In patients scheduled for elective lower limb orthopaedic procedures, intrathecal nalbuphine 1 mg as an adjuvant to 0.5% hyperbaric bupivacaine for subarachnoid block extend the duration of sensory block, motor block, and the postoperative analgesia more successfully than intrathecal fentanyl 25 μg.

Effects of intrathecal dexmedetomidine coadministered with hyperbaric bupivacaine in the lower abdominal surgery: Results of a double-blind, randomized, and controlled trial between two different doses

Background: Although various adjuvants have been added to local anesthetic agents to potentiate its effect, dexmedetomidine is a relatively new drug with only a fewer studies. Aims and Objectives: The present study has been conducted to compare the efficacy of intrathecal hyperbaric bupivacaine alone with dexmedetomidine of two different doses as adjuvants in spinal anesthesia for the lower abdominal surgery. Materials and Methods: This was a double-blinded, randomized, and controlled trial. Total 120 patients of American Society of Anesthesiologists physical status I and II, 70 male and 50 female, aged between 20 and 60 years, were randomized into three groups receiving 15 mg 0.5% hyperbaric bupivacaine with normal saline, 4 μg (microgram) dexmedetomidine, and 2 μg dexmedetomidine, respectively, administered intrathecally. Results: There was significant difference among all three groups with regard to the onset of sensory block and time to reach the highest level of sensory block. Time to reach T10 dermatome, time to reach Bromage 3 motor block, the mean regression time to S1 dermatome level, the mean regression time to reach Bromage 0, and time to first requirement of rescue analgesia – all these variables showed significance when 4 μg dexmedetomidine additive group was compared with 2 μg dexmedetomidine additive group and bupivacaine alone group. Conclusion: In our double-blinded, randomized, and controlled trial, 4 μg intrathecal dexmedetomidine coadministered with 0.5% hyperbaric bupivacaine showed superior efficacy. Further, larger trials are needed to confirm our findings.

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

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

Comparison of the Local Anesthetic Effect of Two Doses of Dexmedetomidine , 5µg and 10µg added to Intrathecal Hyperbaric Bupivacaine

Objective:To Ascertain the optimum intrathecal dose of dexmedetomidine along with local anesthetic. Method: Prospective randomized study, Place and Duration of Study was in the Department of Anaesthesia, FMHCollege ofMedicine&amp;Dentistry,Lahore from1st.February to 31st.July (6months) 2021. Ninety patients posted for urological, lower abdominal and pelvic general surgical procedures selected for the study were distributed in three groups. All groups comprised 30 patients each. Our facility is providing treatment to infertile males and that was our main study population.We selectedASA1&amp;2 patients between 20 and 60 years.The first group [Control (C)] received only local anesthetic (2 ml. of hyperbaric bupivacaine 0.75%) plus 0.5 ml normal saline. The second group [Dexmedetomidine (D1)] received in addition to local anesthetic 5 micrograms of dexmedetomidine.The third group [Dexmedetomidine (D2)]received in addition to local anesthetic 10 µg of dexmedetomidine. The duration of surgical anesthesia, motor blockade and severity of side effects (hypotension and bradycardia) were noted for all patients in all the three groups. All the groups received 2.5 ml intrathecal injection. Results: The onset of the blockade was similar in all groups. The duration of block was maximally prolonged in (D2) group. The duration was in between in (D1) group. It was minimum in (C) group. Conclusion: Intrathecal use of dexmedetomidine with local anesthetic prolonged the sensory and motor blockade and 5 µg was found to be the optimal dose. How to cite: Abaidullah K, Siddiqi KJ, Khan MA, Ahmad M, Awais M. Khalid R. Comparison of the Local Anesthetic Effect of Two Doses of Dexmedetomidine , 5µg and 10µg added to Intrathecal Hyperbaric Bupivacaine Esculapio - JSIMS 2022;18(04):248-252

A COMPARATIVE STUDY OF THE EFFECTS OF INTRATHECAL MIDAZOLAM(1MG) AND FENTANYL(25 MICROGRAMS) AS ADDITIVES TO INTRATHECAL HYPERBARIC BUPIVACAINE 0.5%(15MG) IN SPINALANAESTHESIA

Background: Various intrathecal additives are added to local anesthetics to increase the speed of onset, improve the quality, and prolong the inuence of spinal anesthesia. Midazolam has a synergistic effect on postoperative analgesia when administered intrathecally with bupivacaine. Opioids such as fentanyl are extensively used as an adjunct to local anesthetics in neuraxial blockade to enhance the duration of postoperative analgesia. Aim: The aim of our study was to compare the effects of intrathecal midazolam(1mg) and fentanyl (25 micrograms) as additives to intrathecal hyperbaric bupivacaine 0.5% (15mg) with spinal anesthesia.Materials and Methods: Prospective, observational study was conducted at SRI SIDDHARTHAMEDICAL COLLEGE AND RESEARCH INSTITUTE,TUMKUR. from 1st Jan 2021 to 30th June 2022 on 94 patients. Results: In Bupivacaine and Midazolam group, mean duration of surgery was 84 ± 12.3 minutes and in Bupivacaine and Fentanyl group, mean duration of surgery was 92 ± 14.4 minutes. In Bupivacaine and Midazolam group, mean time for onset of sensory block was 7.1 ± 0.9 minutes and in Bupivacaine and Fentanyl group, mean time for onset of sensory block was 6.9 ± 1.1 minutes. In Bupivacaine and Midazolam group, mean time for onset of motor block was 7.6 ± 1.3 minutes and in Bupivacaine and Fentanyl group, mean time for onset of motor block was 8.1± 1.2 minutes. In Bupivacaine and Midazolam group, mean duration of sensory block was 213.6 ± 16.1 minutes and in Bupivacaine and Fentanyl group, mean duration of sensory block was 218.3 ± 19.2 minutes. Conclusion- The onset of sensory and motor blockade was comparable in Fentanyl with Bupivacaine and Midazolam with Bupivacaine. Additional of intrathecal Fentanyl prolonged the duration of analgesia signicantly than that of Midazolam. There was signicantly less consumption of rescue of analgesia among patients with Fentanyl with Bupivacaine than Midazolam with Bupivacaine. The duration of postoperative analgesia was also signicantly prolonged in the fentanyl and midazolam groups

Comparison of fentanyl and nalbuphine as adjuvants to intrathecal 0.5% bupivacaine in lower limb surgeries: A randomised double-blind prospective study.

Local anaesthetics used in spinal anaesthesia have a limited duration of action. To prolong postoperative analgesia, adjuvants, mainly opioids, are used. As µ agonist drugs have side effects, other receptor agonists are considered. Nalbuphine is a safe and effective kappa agonist adjuvant. To compare the analgesic efficacy between fentanyl and nalbuphine adjuvants added to 3 mL of 0.5% intrathecal hyperbaric bupivacaine. This prospective, double-blind, comparative study was conducted in 60 patients of either sex belonging to the American Society of Anesthesiologists classes I and II aged 18-65 years undergoing lower limb surgery with entropy monitoring, randomly allocated into two groups. Group F (n = 30) received 0.5% hyperbaric bupivacaine (3 mL) + 25 µg (0.5 mL) fentanyl. Group N (n = 30) received 0.5% hyperbaric bupivacaine (3 ml) + 0.8 mg (0.5 mL) nalbuphine intrathecally. Hemodynamics, entropy, motor and sensory block characteristics, and complications were noted. The nalbuphine group had a significantly longer two-segment regression time of sensory blockade and extended analgesia duration than the fentanyl group. Haemodynamics, entropy, time for onset of sensory and motor blockade and adverse effects were comparable in both groups. Nalbuphine prolongs sensory blockade and postoperative analgesia duration with minimal side effects and is a safe intrathecal adjuvant.

Comparison between 10 and 12 mg doses of intrathecal hyperbaric (0.5%) bupivacaine on sensory block level after first spinal failure in cesarean section: A double-blind, randomized clinical trial.

BackgroundReducing adverse effects during cesarean delivery and improving the quality of sensory blocks with appropriate doses of intrathecal hyperbaric bupivacaine can play an important role in the safe management of cesarean delivery. The aim of this study was to compare the doses of 10 and 12 mg of intrathecal hyperbaric bupivacaine 0.5% on sensory block level after first spinal failure in cesarean section (CS).MethodsIn this double-blind, randomized clinical trial, 40 candidates of CS after first spinal failure with class I-II based on American Society of Anesthesiologists (ASA) were randomly assigned into two equal groups (n = 20). Group A and B received the spinal anesthesia with 10 mg and 12 mg of hyperbaric bupivacaine (0.5%), respectively. Maximum levels of sensory block, motor block quality, and vital signs were measured in two groups by 60 min after SPA. Incidence of SPA complications during surgery were also recorded. Data were analyzed by SPSS ver.21 software using repeated measures analysis of variance at 95% confidence interval (CI) level.ResultsExcellent quality of sensory blocks and complete quality of motor blocks were achieved in all participants (100%). However, the mean time to onset of anesthesia (4.47 ± 0.69 vs. 3.38 ± 0.47, P < 0.001) and time to reach T10 level (60.73 ± 11.92 vs. 79.00 ± 19.21, P < 0.001) in the Group A, were significantly shorter than in the patients of Group B. The incidence of hypotension (P = 0.001), nausea/vomiting (P = 0.007) and bradycardia (P = 0.012) as well as administration of ephedrine and atropine were significantly higher in Group B compared to Group A.ConclusionSpinal anesthesia can be safely repeated with a 10 mg of hyperbaric bupivacaine 0.5% in a caesarean section after the initial spinal failure.Clinical trial registration[https://en.irct.ir/trial/40714], identifier [IRCT20120915010841N20].

Association Between Hyperbaric Bupivacaine Dose and Maternal Hypotension: Retrospective Database Study of 8226 Women Undergoing Cesarean Delivery Under Spinal Anesthesia

(Anesth Analg. 2021;133:967–975) Maternal hypotension is common following an intrathecal hyperbaric bupivacaine dose for cesarean delivery. Studies have varied results or insufficient data when investigating the optimal dose of hyperbaric bupivacaine to reduce the incidence of hypotension. The aim of the study was to determine the relationship between hyperbaric bupivacaine dose and spinal-induced maternal hypotension for women undergoing cesarean delivery.