Level Of Sensory Block Research Articles

Risk prediction score for high spinal block in patients undergoing cesarean delivery: a retrospective cohort study.

High spinal block is a serious complication of spinal anesthesia. However, findings regarding its associated risk factors are inconsistent, and no studies have reported a relevant risk prediction score. We aimed to determine the risk prediction score for high spinal block in patients who were induced spinal anesthesia for cesarean delivery. This retrospective cohort study was conducted at a hospital in Southern Thailand between 2019 and 2020. We recorded demographic characteristics, gestational age (GA), hyperbaric bupivacaine dose, sensory block level, pre- and post-procedure blood pressure, and birth weight. High spinal block was defined as a decrease in pinprick sensation > T4. Risk scores, adjusted odds ratios (OR), and 95% confidence intervals (CI) were determined. Risk scores were derived from the coefficients of the final multivariate logistic regression model. The incidence of high spinal block was 22.4% among the 1003 parturients. Our risk prediction tool for high spinal block had a sensitivity and specificity of 76% and 49%, respectively, and was classified into high (> 21), intermediate (15-21), and low (≤ 14) risk groups. The patient-related predictors were a GA < 35weeks (OR [95% CI]: 2.31 [1.13, 4.71], score of 8), height < 150cm (2.21 [1.11, 4.38], score of 8), and post-pregnancy body mass index > 27.5kg/m2 (2.68 [1.33, 5.41], score of 10). The anesthesia-related predictors were a hyperbaric bupivacaine dose > 11mg (2.56 [1.34, 4.87], score of 9) and induction by a first-year resident (1.48 [1.05, 2.09], score of 4). The surgery-related predictors were previous cesarean delivery in labor (1.83 [1.2, 2.78], score of 6) and elective cesarean delivery (2.53 [1.57, 4.07], score of 9) compared to indication by cephalopelvic disproportion. The incidence of intraoperative hypotension was significantly higher in the high-block group than in the control group (46% vs. 25%, p < 0.001). The combination of patient- and anesthesia-related predictors played an important role in the intermediate- and high-risk groups for high sensory spinal block. Addressing the modifiable risk factors-a GA < 35weeks, an optimal dose of bupivacaine, and the experience level of the spinal block performer-could minimize the risk of high spinal block during cesarean delivery.

Comparison of Low-dose Diluted Hyperbaric Bupivacaine and Standard Hyperbaric Bupivacaine in Subarachnoid Block for Ambulatory Endovenous Laser Ablation of Varicose Vein: A Randomized Controlled Trial

Abstract Background: Low-dose spinal anesthesia represents a highly coveted anesthetic technique for patients undergoing endovenous laser ablation of varicose veins in a day-care setting, given its prompt onset, reliable anesthesia, brief turnover time, and cost-effectiveness. Given that intense motor block is not required for this procedure, this trial compared the efficacy of low-dose diluted hyperbaric bupivacaine with standard hyperbaric bupivacaine in the subarachnoid block for endovenous laser ablation of varicose veins. Methodology: A prospective, randomized controlled trial at a tertiary care hospital, Tamil Nadu, South India. Sixty individuals with varicose veins requiring endovenous laser ablation surgery were split at random into two groups. Group A (n = 30) got 0.5% hyperbaric bupivacaine 10 mg (2 ml), Group B (n = 30) got diluted hyperbaric bupivacaine 5 mg (1 ml of 0.5% hyperbaric bupivacaine diluted with an equivalent volume of normal saline) intrathecally. This study evaluated the time to surgical readiness, peak sensory block level, motor block grade, sensory block level at the completion of surgery, duration of motor and sensory blocks, and timing of discharge. Results: The median peak sensory block level for Group A was T6 (T8–T6), whereas for Group B it was T8 (T10–T6), with a P = 0.03. At the conclusion of surgery, the median sensory block level was T6 (T6–T8) for Group A and T8 (T7–T10) for Group B. No patients in either group needed a rescue analgesic. The average timing of discharge for Group B was shorter (P = 0.00002). Conclusion: For patients receiving endovenous laser ablation therapy for varicose veins, subarachnoid blockade with low-dose diluted hyperbaric bupivacaine (5 mg) offers an effective anesthesia, the best recovery profile, and early hospital discharge.

Effect of esketamine on hypotension in women with preoperative anxiety undergoing elective cesarean section: a randomized, double-blind, controlled trial

To investigate the effect of low-doses esketamine on spinal anesthesia-induced hypotension in women with preoperative anxiety undergoing elective cesarean section, the randomized controlled trial enrolled 120 women aged 18–35 years who preoperative State-Trait Anxiety Inventory State scores > 40, conducted from September 2022 to August 2023 in Xuzhou Central Hospital, China. Women in the esketamine group received a single intravenous injection of 0.2 mg/kg esketamine after sensory block level achieved. The incidence of hypotension in the esketamine group was significantly lower than the control group at T2 (10% [6 of 60]; P < 0.001), T3 (5.0% [3 of 60]; P = 0.007) and T4(5.0% [3 of 60]; P = 0.004). Despite being higher in the esketamine group, the overall rates of hypertension (11.7% [7 of 60]; P = 0.186), tachycardia (23.3% [14 of 60]; P = 0.246), and bradycardia (0.0% [0 of 60]; P = 0.079) were no significantly difference between the two groups. STAI-S scores was significantly lower in the esketamine group (mean [SD] 37.52[7.14]) than in the control group (mean [SD] 41.03[9.66], P = 0.39) in postoperative day 1. Spinal anesthesia combined with intravenous low-doses esketamine infusion can significantly reduce the incidence of hypotension in women with preoperative anxiety undergoing elective cesarean section.

Pain during caesarean delivery in a tertiary maternity hospital: a retrospective cohort study (2022–2023)

BackgroundIntra-operative pain during Caesarean delivery (PDCD) is the leading cause of successful litigation against obstetric anaesthesiologists. PDCD may require conversion to general anaesthesia (GA). The aim of this analysis is to assess our incidence of PDCD and associated GA conversion. MethodsData were collected from electronic patient records. Data included baseline demographics, incidence of PDCD and rates of GA conversion, proportion of PDCD cases attributable to failed epidural (EA) or spinal anaesthesia (SA), and level of sensory and motor blockade in cases of PDCD. Results were audited against current standards set by the Royal College of Anaesthetists ‘rates of PDCD should be <5% for category 4, <15% for categories 2-3, and <20 % for category 1 CD ’ and that ‘rates of conversion to GA due to neuraxial complications should be <1% for category 4, <5% for categories 2-3 and <15% for category 1 patients’. ResultsDuring the 12-month study period, 2,429 patients underwent CD, of whom 52 (2.1%) experienced PDCD. The incidence of PDCD was 3.1% (41/1,309) for category 1-3 patients, while 1% (11/1,120) of category 4 patients experienced PDS. Of the 52 patients with PDCD, 17 patients required GA (33%). SA was used in 24/52 (47%) cases and EA in 28/52 (53%) cases. The median level of sensory block in patients with PDCD was located at the T4 dermatome, the median level of motor block was Bromage level 2. ConclusionsPDCD occurred in 2.1% of CD, one-third required conversion to GA. Most patients experiencing PDCD met current motor and sensory blockade criteria.

Effect of Bilateral Erector Spinae Plane Block on Postoperative Analgesia in Cesarean Section Under Spinal Anaesthesia: A Prospective Randomized Controlled Trial.

Acute pain after cesarean section (CS) can affect the quality of life of patients. This study aimed to assess the impact of bilateral erector spinae plane block (ESPB) under spinal anaesthesia on postoperative pain, analgesic usage, and patient satisfaction in elective CS. A total of 116 ASA II females aged 18-45 years who had elective CS were included in this prospective randomized study. Adjusted for the patient's height and weight, 0.5% bupivacaine and 12.5 μg fentanyl were administered for spinal anaesthesia. In the ESPB group, ultrasonography-guided ESPB with 10 mL 0.5% bupivacaine+10 mL saline was applied bilaterally at the T12 vertebrae level at the end of the surgery. Postoperative analgesia was planned with diclofenac and paracetamol. Patients' satisfaction, analgesic usage, rest, movement, cough, and low back pain were evaluated using a visual analogue scale (VAS) at postoperative hours 2, 4, 6, 12, and 24. The extent of the sensory block level of ESPB was evaluated after the spinal anaesthesia had worn off. The analysis included 49 patients in the ESPB group and 50 in the control group with comparable demographics. Rest, movement, and cough VAS scores were substantially lower at the 2nd, 4th, 6th, and 12th h in the ESPB group, and satisfaction was better. Total analgesic consumption and the need for rescue analgesics were higher in the control group. VAS scores and ESPB spread levels are negatively correlated. As a safe component of multimodal analgesia following CS, bilateral ESPB can be effectively performed.

Comparison of the analgesic effects of different bupivacaine concentrations in continuous femoral block after total knee arthroplasty surgery

Aim: In regional anesthesia practice, anesthesists’ goal must be to use the lowest effective concentration of local anesthetics to provide sufficient pain relief while minimizing side effects and complications. This study was designed to compare the analgesic efficacy of two different concentrations of bupivacaine (0.125% and 0.1%) in continuous femoral block for postoperative analgesia.Method: In this study, fifty patients were enrolled, all of whom underwent femoral nerve block catheterization. The block procedure involved the administration of 30ml of bupivacaine solution at a concentration of 0.25%. Following a thirty-minute interval post-block application, patients underwent knee surgery under general anesthesia. During the closure of subcutaneous tissues, an additional 10ml of bupivacaine solution was injected through the catheter. Two groups were formed based on the concentration of the solution administered: Group(0.125%) received bupivacaine at a concentration of 0.125%, while Group(0.1%) received it at a concentration of 0.1%. Subsequently, upon arrival at the postoperative care unit, infusion through the catheter commenced at a rate of 10ml/h-1, maintaining the same concentrations for both groups. In addition to the nerve block, all patients were provided with intravenous Patient Controlled Analgesia (PCA) devices containing morphine for pain management. Throughout the postoperative period, sensory and motor block levels, Numerical Rating Scale (NRS) values for static and dynamic pain assessment, total morphine consumption, morphine demand, as well as any observed side effects and complications, were meticulously recorded for analysis.Results: Postoperatively the NRSstatic values at 24th and 48th hours and NRSdynamic values at the 24th hour were higher in Group(0.1%) and it was statistically significant(p&lt;0,007). And at 48th hour, morphine consumption was significantly higher in Group(0.1%) (p&lt;0,05).Conclusions: In our study, all patients across both experimental groups initially experienced satisfactory analgesia. However, within the 24-hour postoperative period, Group(0.1%) exhibited a decline in the quality of analgesia, necessitating increased utilization of rescue analgesics. This escalation in rescue analgesic use was associated with a higher incidence of adverse effects and reduced patient comfort levels within this group. Consequently, our findings indicate that the 0.125% concentration of bupivacaine yielded superior efficacy compared to the 0.1% concentration in the context of continuous femoral block administration.

Differential sensory block during labour epidural analgesia: a prospective observational study to investigate the relationship of lower and upper sensory block levels to cold, pinprick, and light touch.

A zone of differential block to cold has been recently documented during labour epidural analgesia, with an upper sensory block level (USBL) and a lower sensory block level (LSBL). We aimed to determine the correlation between USBL and LSBL to cold and pinprick and sensory block level to light touch during labour epidural analgesia. We conducted a prospective observational study in patients requesting labour epidural analgesia. We placed an epidural catheter at L2/L3 or L3/L4, followed by a programmed intermittent epidural bolus plus patient-controlled epidural analgesia regimen. We assessed the sensory block levels 140min after administering the loading dose. The primary outcomes were the USBL and LSBL to cold and pinprick and the sensory block level to light touch. We studied 30 patients. The median [interquartile range (IQR)] USBL and LSBL to ice were T7 [T7-T6] and T9 [T10-T8], respectively. The median [IQR] USBL and LSBL to pinprick were T8 [T10-T6] and T10 [T12-T10], respectively. There was a strong correlation between USBL to ice and pinprick (Spearman correlation coefficient, 0.57) and between LSBL to ice and pinprick (Spearman correlation coefficient, 0.52). There was no significant correlation between sensory block level to light touch and either USBL or LSBL to ice or pinprick. We observed two sensory block levels to ice and pinprick. Further studies are required to understand if one modality-cold or pinprick-is superior to the other in assessing sensory block levels in this context. Light touch is unreliable as a modality of sensory block assessment during labour epidural analgesia. ClinicalTrials.gov (NCT05187962); registered 12 January 2022.

A Prospective Randomized Controlled Double Blinded Interventional Study to Compare Post Operative Analgesia Using Sequential Intrathecal Injection of Fentanyl at Different Rates with Hyperbaric Bupivacaine in Lower Segment Caesarean Sections

Background: This study compared rapid and slow intrathecal fentanyl injection followed by a slow injection of bupivacaine to estimate the duration of postoperative analgesia in lower-segment caesarean sections (LSCS). Methods: The study was performed on 60 parturient aged 18-35 years undergoing LSCS and was divided equally into two groups. Group A (Normal Sequential) received slow sequential intrathecal injections of fentanyl and hyperbaric bupivacaine and Group B (Rapid Sequential) received a rapid intrathecal injection of fentanyl followed by a slow injection of hyperbaric bupivacaine. We compared the duration of postoperative analgesia, time of onset of sensory and motor block attained, the highest level of sensory block attained, duration of motor block, Visual Analogue Scale (VAS) scores, spinal anaesthesia-related complications and haemodynamic parameters between both the groups. Results: The duration of postoperative analgesia was longer (P &lt; 0.001) in group B (3.22 ± 0.66 hrs) as compared to group A (2.53 ± 0.41 hrs.) The onset of sensory block was faster (P &lt; 0.001) in group B (1.01 ± 0.29 min) as compared to group A (1.32 ± 0.08 min). More patients in group B achieved higher levels of sensory blockade as compared to group A (5 patients in group A and 12 patients ofgroup B achieved a sensory block up to the T2 dermatome). VAS scores and the requirement of rescue analgesia were significantly lower (10 in group B and 19 in group A). Conclusion: Rapid sequential intrathecal injection of fentanyl and hyperbaric bupivacaine provided better anaesthesia and postoperative analgesia than the normal group.

Transüretral Cerrahi Vakalarinda, Sürekli Spinal ve Tek Doz Spinal Anestezi Tekniklerinin Hemodinami, Duyusal ve Motor Blok Seviyesi Üzerine Etkilerinin Karşilaştirilmasi

Aim: In this study, it was aimed to compare in patients undergoing transurethral resection surgery: 1- The effectiveness of single-dose and continuous spinal anesthesia techniques, 2- Hemodynamic changes, sensory-motor block levels and durations, anesthetic drug doses and side effects. Method: Forty American Society of Anesthesiology I–III patients in the age group of 40–75 years who were scheduled for transurethral surgery were randomly divided into two groups: single dose spinal anesthesia (Group 1) (n = 20) and continuous spinal anesthesia (Group 2) (n = 20). The patients' hemodynamic data, analgesia status and motor block levels were evaluated. Results: With regard to the hemodynamic parameters, the mean values of systolic–diastolic blood pressure and heart rate were found to be significantly lower in the single dose spinal anesthesia group (Group 1) than in the continuous spinal anesthesia group (p &amp;lt; 0.05). In terms of sensory and motor block levels, the maximum block level was T9 in the continuous spinal anesthesia group, while it was T8 in the single dose spinal anesthesia group (p &amp;lt; 0.05). Upon reaching T10, two-segment regression and sensory and motor block termination times were found to be significantly lower in the continuous spinal anesthesia group when compared to the single dose spinal anesthesia group (p &amp;lt; 0.05). There was no difference between the two groups in terms of Bromage score values (p &amp;gt; 0.05). In the continuous spinal anesthesia group, the mean dose and volume of the local anesthetic required to achieve analgesia in the T10 dermatome were found to be 7.12 ± 1.46 ml and 1.4 ± 0.29, respectively. Furthermore, the amount of fluid administered intraoperatively was found to be significantly lower in the continuous spinal anesthesia group than in the single dose group (p &amp;lt; 0.05). Conclusion: With the continuous spinal anesthesia method, it can be titrated and by using lower doses of local anesthetic, a level of sensory-motor blockade close to the single-dose spinal anesthesia method and a more stable hemodynamics can be achieved.

A Comparative Study of Bupivacaine and Bupivacaine with Fentanyl for Subarachnoid Block

Introduction: Subarachnoid block (SAB) is the anesthesia of choice for lower abdominal and lower limb surgeries. The objective of the study was to evaluate and compare the onset, duration, recovery of neural blockade, hemodynamic changes and side effects of bupivacaine alone with fentanyl added to bupivacaine.Materials and methods: This cross sectional comparative study was conducted in Department of Anaesthesia at National Medical College in 82 patients from April 2023 to September 2023 . Patients of either sex as per American Society of Anaesesiologists, Physical Status I-II between age 20- 60 years were randomly allocated to one of two groups of 41 each.Results: This study showed that there was highly significant difference in the highest level of sensory block achieved between mthe two groups (p &lt; 0.001 ) and motor blockade. Most of patients receiving bupivacaine alone (Group B) had achieved T6 dermatomal sensory level block and Bromage score of 4, while patients receiving fentanyl with bupivacaine (Group F) achieved T8 and also Bromage score of 3 respectively. The mean duration for highest sensory level in group F and group B was 7.76 and 9.66 minutes, respectively. The mean duration for 2 segment regression in group F and group B was 95.28 and 67.24 minutes respectively. Hypotension was significantly high in Group B.Conclusion: Fentanyl added to bupivacaine has an earlier onset of action, prolonged sensory analgesia but earlier motor recovery compared to bupivacaine alone but a comparatively lower sensory dermatomal level without complete motor blockade, adequate for surgical procedures.

Intravenous Ondansetron Efficacy in Preventing Post Spinal Shivering during Lower Segment Caesarean Section

Objective: To determine IV Ondansetron efficacy in preventing post-spinal shivering during LSCS. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Anaesthesiology, Combined Military Hospital, Rawalpindi Pakistan, from Sep 2018 to Mar 2019. Methodology: A total of 60 women undergoing LSCS under spinal anaesthesia were included. Group-A was given 8 mg/4 ml Ondansetron, while Group-B was given 4 ml Normal Saline 0.9% IV immediately before induction of spinal anaesthesia. Body temperature, level of sensory block, and shivering scores during the peri-operative period were recorded. After surgery, patients were shifted to Post Anaesthesia Care Unit (PACU). Shivering was graded using Crossley and Mahajan 5-item scale. Injection Tramadol 1mg/kg intravenously was used as a rescue anti-shivering drug. Results: The majority of the patients 33(55.0%) were between 18-25 years of age. Efficacy of Intravenous Ondansetron in preventing post-operative shivering during spinal anaesthesia in patients undergoing caesarean section was seen in 26 86(67%) patients (Group-A) as compared to 17(56.67%) patients in the Control Group (Group-B) (p-value=0.010). Conclusion: The study concluded that there was less post-operative shivering with intravenous Ondansetron during spinal anaesthesia in patients undergoing caesarean section as compared to the Control Group.

Study of effectiveness of two syringe spinal anaesthesia technique for caesarean section

Spinal anaesthesia using hyperbaric bupivacaine is the most popular method for caesarean section. Adjuvents like fentanyl which enhances the sensory block and provide stable haemodynamics are usually premixed with bupivacaine in a single syringe. Fentanyl when added to hyperbaric bupivacaine, decreases the density of solution to extent of 0.0006 which alters the spread of local anesthetics in CSF. If we inject both the drugs separately in different syringe, it may minimize the effect of the changes in densities and PH of both the drugs and produce their maximum effect with minimal haemodynamic alteration. Therefore this study was conducted to see the quality of sensory block and haemodynamic response by sequential intrathecal administration of fentanyl and hyperbaric bupivacaine in two different syringe for patients undergoing caesarian section. This interventional study was carried out in Seventy nine Patients undergoing caesarean section under spinal anesthesia with 0.5% hyperbaric bupivacaine 9mg (1.8 ml) and fentanyl 20 mcg in two different syringe administered sequentially. Out of 79 parturients only 22 (27.85%) had hypotension requiring vasopressor treatment during caesarean section and maximum amount of vasopressor used was 15 mg of mephentermine. The mean level of maximum sensory block after 20 mins of spinal anaesthesia was T2 in 20 (25.32%) patients, T3 in 19 (24.05%) patients, T4 in 32 (40.51%) patients, T5 in 1 (1.27%) patient and T6 in 7 (8.86%) Patients. Intraoperative quality of surgical anaesthesia was very satisfactory to the patients. Only 6 (7.59%) patients had mild discomfort whithout requirement of any medical treatment. The result of this study concluded that separate intrathecal injection of fentanyl and hyperbaric bupivacaine provides better haemodynamic stability, improves quality of surgical anaethesia allowing it to work at higher levels in the spinal cord with minimal other side effects in patient undergoing caesarean section.

Changes in Sensory Block Level During a Programmed Intermittent Epidural Bolus Regimen for Labor Analgesia: A Prospective Observational Cohort Study

(Can J Anesth/J Can Anesth. 2022;69:1471–1476) Currently, one of the most widely used methods of pain management is epidural analgesia, with drug delivery in a programmed intermittent epidural bolus (PIEB) in conjunction with patient-controlled epidural analgesia. Previously the investigators reported 2 sensory block levels associated with epidural analgesia: (1) upper sensory block level (USBL), the highest dermatome with any altered sensation to cold, and (2) lower sensory block level (LSBL), the highest dermatome with complete sensory block to cold. The purpose of this study was to further explore these sensory block levels and how they change over time with PIEB and patient-controlled epidural analgesia as a pain management method.

Effect of height-based spinal anesthetic dose versus conventional dose on hemodynamics in lower limb surgeries in geriatric patients: a randomized controlled trial

Background: An adequate dose of spinal anesthetic is very crucial in elderly surgical patients. The routine method to calculate the dose in a particular patient is usually based upon the weight of the patient, but the effect cannot always be predictable. We evaluated the efficacy and safety of the height-based dose of spinal anesthetic versus the conventional dose on intraoperative hemodynamics and spinal block characteristics in geriatric patients scheduled for lower limb surgeries.&#x0D; Methodology: This single-blinded, parallel-group, randomized, clinical trial enrolled 56 patients, aged 60 y or above who were scheduled for lower limb orthopedic surgeries under spinal anesthesia. The patients were randomly divided into two groups. In the height-based group, 0.06 mg of 0.5% hyperbaric bupivacaine/cm height of the patient was administered intrathecally. The control group received a fixed dose of 12.5 mg of 0.5% hyperbaric bupivacaine intrathecally. All patients received 25 µg of fentanyl (0.1 mg / 2 ml) intrathecally. The incidence of hypotension was the primary outcome. The incidence of bradycardia, highest sensory level, onset and duration of sensory and motor block, incidence of shivering, the total dose of bupivacaine, total amount of fluid infused, vasopressors needed, and blood loss were the secondary outcomes.&#x0D; Results: The incidence of hypotension was significantly reduced in patients receiving height-based spinal dose compared to those in which standard dose was administered (57.1% vs. 82.1%, P = 0.042). The duration of sensory blocks was significantly shorter in height-based group compared to the control group (116 ± 32.77 vs. 90.59 ± 19.66 min; P = 0.001) as was the duration of the motor block (153.18 ± 42 and 117 ± 25.37 min; P &lt; 0.001).&#x0D; Conclusion: In geriatric patients undergoing orthopedic lower limb surgery, the height-based dose of spinal anesthesia was effective and safe in reducing the incidence of hypotension with fast recovery from sensory and motor block.&#x0D; Abbreviations: ASA- American Society of Anesthesiologists; COPD- Chronic Obstructive Pulmonary Disease; CSF- Cerebrospinal Fluid; DVT- Deep Venous Thrombosis; IQR- Interquartile range- n: Numbers; SD- Standard Deviation; SA- Spinal Anesthesia&#x0D; Key words: Bromage scale; Elderly; Height; Hypotension; Orthopedics; Anesthesia, Spinal&#x0D; Citation: Alkonaiesy TM, Amin SM, Abdallah NM, Sherif Ismail Muhammad SI, Hassan H. Effect of height-based spinal anesthetic dose versus conventional dose on hemodynamics in lower limb surgeries in geriatric patients: a randomized controlled trial. Anaesth. pain intensive care 2023;27(4):565−572; DOI: 10.35975/apic.v27i4.2160&#x0D; Received: February 20, 2023; Reviewed: May 16, 2023; Accepted: June 16, 2023

Effect of interfascial pressure on block success during anterior quadratus lumborum block application: a prospective observational study.

The quadratus lumborum block (QLB) has recently been used frequently for postoperative analgesia after abdominal surgery. The aim of this study was to investigate the effect of pressure changes between the middle thoracolumbar fascia layers to which the anterior QLB (aQLB) is applied at the level of the sensory block. A total of 67 patients planned to undergo laparoscopic cholecystectomy were evaluated in the context of this prospective study. Bilateral aQLBs were administered to all patients, and a peripheral nerve block catheter was placed between the psoas and quadratus lumborum muscles. The correlation of interfascial pressures (IFPs) during block application, 30 min intraoperatively, and 30 min postoperatively with the sensory block level was determined as the primary outcome measure. Secondary outcome measures were the sensory block levels 30 min after block application and 30 min postoperatively; visual analog scale scores 30 min and 6, 12, and 24 h postoperatively; and 24 h tramadol consumption. The preoperatively and intraoperatively measured IFPs differed significantly between the right and left sides (P < 0.05). The preoperative and postoperative block levels also differed significantly between the right and left sides (P < 0.05). The preoperative and postoperative block levels and preoperatively measured IFPs showed a weakly negative correlation (right: r = 0.374; left: r = 0.470). The results of this study show that pressure changes between the fasciae may be effective in aQLB application.

Effect of position - Trendelenburg and horizontal on the height of sensory block in patients undergoing lower abdominal surgery

Background: Subarachnoid anesthesia also known as spinal anesthesia is now considered to be a safe form of anesthesia for lower abdominal and lower limb surgeries. The height of sensory block achieved in spinal anesthesia after drug administration can be altered by changing the position of the patient, and this precisely is the advantage of using hyperbaric local anesthetic drug. Aims and Objectives: The aim of this study is to compare the effect of position – horizontal and Trendelenburg on the height of sensory block in spinal anesthesia. Materials and Methods: After obtaining the institutional ethical clearance, total 66 patients scheduled for lower abdominal surgery under spinal anesthesia were selected and divided into two groups – Group A patients were placed in Trendelenburg position with 20° head down for 40 s and then returned to horizontal position and Group B patients were placed in horizontal position after spinal anesthesia. The level of sensory block was compared among the two groups at different points of time up to 30 min of drug administration. Results: The patients who remained in Trendelenburg position for 40 s after spinal anesthesia achieved a higher level of sensory block earlier as compared to the horizontal group and the maximum block height was two spinal segments higher than that of the horizontal group. Conclusion: From our current study, we can conclude that Trendelenburg position can be used to achieve a higher level of sensory block as compared to horizontal position after successful neuraxial block.

A Study of the Clinical Effects of Sequential Combined Spinal Epidural Anesthesia and Spinal Anesthesia in Patients Undergoing Orthopedic Surgeries.

In orthopedic surgeries, there has been an increase in the usage of the neuraxial blockade to provide excellent surgical conditions and prolonged postoperative analgesia. The introduction of the sequential combined spinal epidural anesthesia (SCSEA) technique provides benefits for both spinal anesthesia (SA) and epiduralanesthesia. The focus of this study was to analyze the time needed to attain a desired level of sensory block, to compare the period of sensory block, and to study the intraoperative hemodynamics in the SCSEA and SA groups. The study was conducted on patients admitted for elective lower limb orthopedic surgeries. The sample size for this prospective randomized study is two groups of 67 subjects each. Patients aged between 18 and 65 years, posted for orthopedic surgeries for two to three hours, and of American Society of Anaesthesiologists (ASA) Grades 1 and 2 were included and divided into two groups. Group A patients received SCSEA with an epidural-test dose of 3 ml lignocaine (2%) with adrenaline and spinal bupivacaine (0.5%) of 1.5 ml-7.5 mg + fentanyl .25 mic if the sensory level was below T8. An epidural top-up was given with 2 ml per segment of 0.5% bupivacaine to bring the sensory level to T8. Group B patients received SA with spinal bupivacaine (0.5%) of 3 ml-15 mg + fentanyl .25 mic. Intraoperative hemodynamics, the duration to achieve a sensory level of T8, the time for two-segment regression of sensory block, and the complications that occurred were recorded. The study included a total of 134 subjects with each group having 67 subjects admitted for lower limb surgery. The mean value (SD) of the time taken to attain sensory block in the SCSEA group was prolonged when compared to the SA group (7.15 ± 0.75 and 5.01 ± 0.88). The time for two-segment regression in the SCSEA group was 86.77 ± 3.60and the SA group was 106.4 ± 8.01, which indicated that the SA group has a longer and better sensory block. Substantially, the study shows that the SCSEA group (P< 0.05) has better hemodynamics when compared to the SA group. The SCSEA technique has better intraoperative hemodynamic stability with a longer analgesic effect when compared to SA. SA shows a sudden change in hemodynamics but reveals a greatersensory block.

An observational study to compare the effect of intravenous dexmedetomidine versus intravenous magnesium sulphate pretreatment on characteristics of spinal anaesthesia

The study was conducted to assess &amp; compare the effect of pretreatment with intravenous Dexmedetomidine and Magnesium sulphate on characteristics of SAB with hyperbaric bupivacaine. 80 ASA grade I and II patients (age: 18-60 years) scheduled for infraumblical surgery under spinal anesthesia were included &amp; randomly divided into group-D (dexmedetomidine 1μ gm/kg) and group-M (magnesium sulfate 50 mg/kg). patients were given prefixed doses of either intravenous dexmedetomidine or Magnesium sulfate 15 mins before SAB. Incidence of hypotension, highest level &amp; duration of sensory &amp; motor blockage, duration of analgesia, vasopressor requirement and incidence of sedation, nausea &amp; vomiting were compared. highest upper level of sensory block after SAB was higher in group-D (p value &amp;#60; 0.001) than group-M. onset of sensory &amp; motor block was earlier &amp; duration of sensory and motor block, time of rescue analgesia was longer in group-D (p value &amp;#60; 0.001). Depth of sedation was higher in group-D though oxygen saturation and respiratory rate was comparable in both groups. Postoperative VAS score (p value &amp;#60; 0.001) was lower in dexmedetomidine group.Study suggests that Intravenous dexmedetomidine at a dose of 1μg/kg is a better adjuvant to 0.5% hyperbaric bupivacaine than MgSo at a dose of 50 mg/kg in infra-umbilical surgeries, with complications of hypotension and bradycardia occurring at acceptable incidences.

A COMPARATIVE STUDY OF CLONIDINE AS ADJUVANT TO ROPIVACAINE AND ROPIVACAINE ALONE IN EPIDURAL ANESTHESIA FOR LOWER LIMB SURGERIES

Introduction:Epidural anaesthesia is one of the most common regional anaesthetic techniques used for lower abdominal and lower limb surgeries. Due to similar analgesic properties, lesser motor blockade and decreased cardiotoxic tendency ropivacaine is increasingly used instead of bupivacaine now a days. Clonidine has been frequently used as an adjunct to local anesthetics because it improves the quality of anesthesia, reduces the dose requirement of the anesthetic agent and provides a more stable cardiovascular course. Aims And Objectives: 1. To evaluate effect of ropivacaine alone in epidural anaesthesia for lower limb surgeries. 2. To evaluate effect of clonidine as adjuvant to ropivacaine in epidural anaesthesia for lower limb surgeries. 3. To compare effect of ropivacaine alone and clonidine as adjuvant to ropivacaine in epidural anaesthesia for lower limb surgeries. Material And Method: The study was conducted in the department of Anaesthesiology, GGS Medical College, Faridkot, after approval by Hospital Ethical Committee. Written informed consent was obtained from each patient. The total of 90 patients were allocated into 2 groups of 45 patients each:1.Group R (n=45) - 19 ml of 0.75% ropivacaine + 1 ml of normal saline (20 ml) 2.Group RC (n=45)-19 ml of 0.75% ropivacaine + 75μg of clonidine diluted to 1 ml (20 ml). The onset time for sensory and motor block, the maximum level of sensory block , duration of analgesia and side effects were recorded. The demographic prole were comparable in terms Results: of age, sex, weight which was statistically nonsignicant in both the groups. Clonidine group (RC) had rapid onset of sensory and motor blockade (p=0.001) and prolonged duration analgesia (p=0.001). There was no statistically signicant difference in HR, SBP, DBP, MAP monitored at various intervals between the two groups. Conclusion: The use of Clonidine as an adjuvant to Ropivacaine for epidural anaesthesia produces early onset of sensory and motor blockage and prolonged the duration of analgesia as compared to ropivacaine alone, with minimal changes in haemodynamic parameters and adverse effects.

Comparison of Intravenous Granisetron and Ondansetron on Hemodynamics and Sensory Motor Block After Spinal Anaesthesia With Hyperbaric Bupivacaine in Patients Undergoing Elective Surgery: A Randomized Double-Blind Study.

Bezold Jarisch reflex (BJR) is mediated by peripheral serotonin receptor 5-HT3 type. BJR and sympathetic blockade are important causes of hypotension and bradycardia after spinal anaesthesia. Premedication with serotonin receptor antagonists has a role in the attenuation of hemodynamic disturbances. To compare the effect of intravenous granisetron and ondansetron on the hemodynamic and sensory-motor block after spinal anaesthesia with hyperbaric bupivacaine in patients undergoing elective surgery. Ninety patients posted for elective surgery under spinal anaesthesia were randomly divided into three groups of 30 each. Group A patients received ondansetron 4mg, group B received granisetron 1mg, and group C received normal saline intravenously. Hemodynamic variables such as heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, and peripheral oxygen saturation, were recorded at baseline and then 2 minutes intervals for 20 minutes and thereafter every 5 minutes till the end of the surgery. The onset and duration of sensory and motor block were recorded at baseline and then every 2 minutes till the complete block was achieved. No patient was excluded from our study. During the intergroup comparison, heart rate and mean arterial pressure remained stable in group A compared to groups B and C. Time to reach peak sensory block level T4 was faster in group A compared to group B and group C. The rate of sensory block regression to two segments (T4 to T6) and thereafter up to T10, T12, andS1 was faster in group B compared to groups A and C. The attainment of complete motor block, Modified Bromage Score (MBS)=4 was faster in group A compared to group B and group C. The rate of motor block regression to MBS=3 and MBS=0 was faster in group B compared to group A and group C. Premedication with ondansetron 4mg and granisetron 1mg intravenously significantly reduces ephedrine use. Ondansetron provides better hemodynamic stability, earlier onset of the sensory and motor blocks as well as prolonged duration of sensory and motor blocks, and duration of analgesia compared to granisetron.