Level Of Sensory Block Research Articles

Effect of Intravenous Dexmedetomidine on Spinal Anesthesia.

BackgroundSubarachnoid block (SAB) with hyperbaric bupivacaine is routinely administered for abdominal and lower limb surgeries. Various agents have been used intrathecally as adjuvants to local anesthetic to increase efficacy and prolong the duration of SAB, among which opioids and α2 agonists are most commonly used. Intravenously administered dexmedetomidine has also been shown to prolong the duration of sensory and motor blockade obtained with subarachnoid block.MethodsA total of 212 adult patients scheduled to undergo abdominal or lower limb surgeries were enrolled in this prospective, double-blind, randomized study. They were divided into two equal groups to receive either intravenous dexmedetomidine (group D) 1μg/kg loading followed by maintenance at 0.5μg/kg or intravenous normal saline (group C) after 15 mins of subarachnoid block; no other intraoperative sedatives were used. The onset of sensory block and motor block, and the highest level of sensory block attained were assessed. The time taken for sensory regression to L1, Modified Bromage scale 0, and rescue analgesia requirement were assessed.ResultsPatients receiving intravenous dexmedetomidine showed no significant change in terms of onset and level of sensory block (P-0.774) and the onset of motor block (P-0.738). The time taken for sensory regression to L1 was significantly prolonged (P-0.000). Also, the time taken to achieve Modified Bromage scale of 0 and time taken for rescue analgesia was significantly prolonged (P-0.000).ConclusionIntravenous dexmedetomidine prolonged the duration of sensory and motor block, and also appears to provide sedation with easy arousability and analgesia postoperatively while maintaining hemodynamic stability with no significant side effects.

Pre-delivery hypotension after spinal anesthesia during cesarean section and its associated factors at Jigme Dorji Wangchuck National Referral Hospital, Bhutan

Introduction: The current choice of anesthesia for the cesarean section is spinal anesthesia. However, hypotension is the major complication. If promptly not recognized and treated, it increases the morbidity and mortality of the mother and fetus. This study was conducted to evaluate the rate of pre-delivery hypotension and risk factors following spinal anesthesia for cesarean section at the National Referral Hospital in Bhutan. Methods: A cohort study was conducted from 1st October 2018 to 30th June 2019 on 350 women undergoing cesarean section under spinal anesthesia. Pre-delivery hypotension was defined as systolic blood pressure < 100 mm Hg. The association of factors for hypotension was tested using multivariable binary logistic regression using a forward stepwise model. A p-value < 0.05 was considered significant. Results: The rate of pre-delivery hypotension was 74.6 % (n=261). History of hypertension during pregnancy (Adjusted OR 0.25, [0.11-0.60], p=0.013), prophylaxis use of ephedrine (Adjusted OR 0.45, [0.22-0.92], p= 0.024) and ondansetron (Adjusted OR 0.43, [0.22-0.82], p= 0.010),longer preoperative fasting duration (Adjusted OR 1.12, [1.01-1.21], p=0.024,), sensory block level <= T4 (Adjusted OR 3.4, [1.8-6.4], p=<0.001) and baseline systolic blood pressure less than or equal to 120 mmHg (Adjusted OR 2.8, [1.5-5.1], p=0.001) were significant risk factors. Conclusions: This study conduces that the rate of pre-delivery hypotension following spinal anesthesia in a cesarean section was high among women undergoing cesarean section. It is alarming as around two-third of women and fetus undergoing cesarean section under spinal anesthesia are at risk of consequences of hypotension. Most of the risk factors in the study are modifiable. The study suggests that if the anesthesia provider intervenes in managing the modifiable risk factors and treat hypotension promptly, it can help reduce the risk of women and fetus to spinal hypotension consequences.

A Prospective Randomised Double Blind Study of Intrathecal Fentanyl and Dexmedetomidine Added to Low Dose Bupivacaine for Spinal Anesthesia for Lower Abdominal Surgeries

Background and Aims. The potentiating effect of short acting lipophilic opioid fentanyl and a more selective α2 agonist dexmedetomidine is used to reduce the dose requirement of bupivacaine and its adverse effects and also to prolong analgesia. In this study, we aimed to find out whether quality of anaesthesia is better with low dose bupivacaine and fentanyl or with low dose bupivacaine and dexmedetomidine Methods. This prospective randomised double-blinded study was carried out in a AL-Zahra teaching Hospital a 150 patients by randomly allocating them into two groups using a computer generated randomisation table. Group F (n = 75) received bupivacaine 0.5% heavy (0.8 ml)+fentanyl 25 μg (0.5 ml) + normal saline 0.3 ml and Group D (n = 75) received bupivacaine 0.5% heavy (0.8 ml) + dexmedetomidine 5 μg (0.05 ml) + normal saline 0.75 ml, aiming for a final concentration of 0.25% of bupivacaine (1.6 ml), administered intrathecally. Time to reach sensory blockade to T10 segment, peak sensory block level (PSBL), time to reach peak block, time to two segment regression (TTSR), the degree of motor block, side-effects, and the perioperative analgesic requirements were assessed. Results. there were no significant differences between the groups in the time to reach T10 segment block (P > 0.05) and TTSR (P > 0.05);time to reach PSBL (P < 0.05) and modified Bromage scales (P < 0.05) were significant. PSBL (P = 0.000) and time to first analgesic request (P = 0.000) were highly significant. All patients were haemodynamically stable and no significant difference in adverse effects was observed. Conclusion .Both groups provided adequate anaesthesia for all lower abdominal surgeries with haemodynamic stability. Dexmedetomidine is superior to fentanyl since it facilitates the spread of the block and offers longer post-operative analgesic duration. Keywords : Dexmedetomidine, fentanyl, low dose bupivacaine, opioids, spinal anaesthesia DOI: 10.7176/JHMN/90-09 Publication date: June 30 th 2021

Sensory block level prediction of spinal anaesthesia with 0.5% hyperbaric bupivacaine: a retrospective study

There is still no consensus on how to determine the dose of spinal anaesthesia with adequate sensory block for a planned surgery. This retrospective study aimed to explore the associations of miscellaneous factors with peak sensory block level after spinal anaesthesia with hyperbaric bupivacaine, and to construct a predictive model for single-shot spinal anaesthesia. We collected the records of 401 non-pregnant adults who underwent spinal anaesthesia with 0.5% hyperbaric bupivacaine at the L3–4 or L4–5 intervertebral space for lower body surgeries. Multiple linear regression analysis was used to investigate predictors of the block level and build up the predictive model. Five variables were identified as independent predictors of the peak sensory block level, including bupivacaine dose, height, weight, gender and age. The predictive model for peak block level after spinal anaesthesia could be expressed as a formula with these five variables and the estimated predictive power was 0.72. Based on this model, it is possible to determine a reasonable dose of hyperbaric bupivacaine for spinal anaesthesia, which gives adequate sensory block required for diverse surgical procedures in various patients and could be considered as a dose reference for sensory block height in spinal anaesthesia.

Laparoscopic Cholecystectomy under Segmental Thoracic Spinal Anesthesia

Introduction: Cholelithiasis or gallstones are hardened deposits of digestive fluid that can form in gallbladder. The treatment of gallstones depends upon the stage of disease. Once gallstones become symptomatic, definitive surgical intervention with cholecystectomy is usually indicated (typically, laparoscopic cholecystectomy is the first-line therapy). Laparoscopic cholecystectomy removes the gallbladder and gallstones through several small incisions in the abdomen. This case report aims to discuss the managent of segmental thoracic spinal anesthesia in laparoscopic cholecystectomy.&#x0D; Case: We report on the cases of 2 patients who undego elective laparoscopic cholecystectomy. Female, 53 years old, will undergo laparoscopic cholecystectomy, performed anesthesia with segmental thoracic spinal anesthesia technique using the anesthetic agent 3 ml of Levobupivacaine 0,5% + 25 mcg of Fentanyl, requiring a sensory block to at least T10-T11 dermatom. Patients received a 1,2 mcg target control infusion (TCI) propofol intravenous is administered as intermittent boluses to achieve deep sedation. The operation lasts 1 hour, with a bleeding 15 cc and urine output 100 cc, hemodynamically stable. Female, 42 years old, will undergo laparoscopic cholecystectomy, performed anesthesia with segmental thoracic spinal anesthesia technique using the anesthetic agent 3 ml of Levobupivacaine 0,5% + 25 mcg of Fentanyl, requiring a sensory block to at least T10-T11 dermatom. Patients received a 3 mg of midazolam intravenous is administered as intermittent boluses to achieve deep sedation. The operation lasts 1 hour, with a bleeding 15 cc and urine output 150 cc, hemodynamically stable. The level and duration of sensory block, intensity and duration of motor block were recorded. A 20 % or more decrease in MAP compared to baseline was considered as hypotension, iv ephedrine 5 mgr bolus administreted.&#x0D; Conclusion: Laparoscopy is a surgical procedure that uses minimally invasive surgical techniques (minimally invasive surgery) where the doctor uses a small telescope / camera that is inserted into the stomach and surgical instruments in mini form. This procedure has many advantages because it is not invasive, the amount of bleeding can be reduced, postoperative pain can be minimized. Regional anesthesia procedure in laparoscopic cholecystectomy based on several studies and case reports can be performed and is a safe procedure.

Laparoscopic Cholecystectomy under Segmental Thoracic Spinal Anesthesia

Introduction: Cholelithiasis or gallstones are hardened deposits of digestive fluid that can form in gallbladder. The treatment of gallstones depends upon the stage of disease. Once gallstones become symptomatic, definitive surgical intervention with cholecystectomy is usually indicated (typically, laparoscopic cholecystectomy is the first-line therapy). Laparoscopic cholecystectomy removes the gallbladder and gallstones through several small incisions in the abdomen. This case report aims to discuss the managent of segmental thoracic spinal anesthesia in laparoscopic cholecystectomy.&#x0D; Case: We report on the cases of 2 patients who undego elective laparoscopic cholecystectomy. Female, 53 years old, will undergo laparoscopic cholecystectomy, performed anesthesia with segmental thoracic spinal anesthesia technique using the anesthetic agent 3 ml of Levobupivacaine 0,5% + 25 mcg of Fentanyl, requiring a sensory block to at least T10-T11 dermatom. Patients received a 1,2 mcg target control infusion (TCI) propofol intravenous is administered as intermittent boluses to achieve deep sedation. The operation lasts 1 hour, with a bleeding 15 cc and urine output 100 cc, hemodynamically stable. Female, 42 years old, will undergo laparoscopic cholecystectomy, performed anesthesia with segmental thoracic spinal anesthesia technique using the anesthetic agent 3 ml of Levobupivacaine 0,5% + 25 mcg of Fentanyl, requiring a sensory block to at least T10-T11 dermatom. Patients received a 3 mg of midazolam intravenous is administered as intermittent boluses to achieve deep sedation. The operation lasts 1 hour, with a bleeding 15 cc and urine output 150 cc, hemodynamically stable. The level and duration of sensory block, intensity and duration of motor block were recorded. A 20 % or more decrease in MAP compared to baseline was considered as hypotension, iv ephedrine 5 mgr bolus administreted.&#x0D; Conclusion: Laparoscopy is a surgical procedure that uses minimally invasive surgical techniques (minimally invasive surgery) where the doctor uses a small telescope / camera that is inserted into the stomach and surgical instruments in mini form. This procedure has many advantages because it is not invasive, the amount of bleeding can be reduced, postoperative pain can be minimized. Regional anesthesia procedure in laparoscopic cholecystectomy based on several studies and case reports can be performed and is a safe procedure.

Comparison of the Effect of Epidural Bolus and Continuous Infusion of Lidocaine %1 on Pain, the Progress of Vaginal Delivery and Motor Function in Labor Epidural Analgesia

Background: The pain of childbirth is the most severe pain that a woman experiences. This study aimed to compare the effect of epidural bolus and epidural continuous infusion of lidocaine %1 on pain and progress of vaginal delivery and motor function in labor epidural analgesia. Methods: This randomized clinical trial was conducted on 50 pregnant women aged between 18-45 years. They were randomly assigned into two groups of bolus injections of lidocaine1% and continuous infusion using an epidural approach. The evaluated variables included systolic and diastolic blood pressures, mean arterial pressure, pain score, heart rate, satisfaction rate, nausea, vomiting, itching, the progress of delivery, and the level of motor and sensory block. The collected data were analyzed in SPSS software (Version 21). P-value less than 0.05 was considered statistically significant. Results: Two groups were similar in age. There were no significant differences between two groups in terms of mean diastolic blood pressure, incidence of hypotension and C/S rate (P&gt; 0.005). Mean arterial pressure, sedation score and neonatal Apgar scores in the first and fifth minutes in the continuous group were significantly lower than the bolus group. Pain score (VAS) in the bolus group) 2.55±1.04 (was significantly lower than infusion group (5.22±2.50). The length of the first and second stages of labor in the bolus group (42.28 and 34.12) was less than continuous infusion (47.04 and 47.00) (P&lt; 0.005). Conclusion: In women undergoing epidural analgesia, epidural bolus injection of lidocaine 1% is associated with greater analgesia and satisfaction than continuous infusion.

Spinal anaesthesia with Chloroprocaine HCl 1% for elective lower limb procedures of short duration: a prospective, randomised, observer-blind study in adult patients

BackgroundThis prospective, randomised, observer-blinded study has been conducted in patients undergoing procedures of the lower extremities to evaluate the time to complete block resolution of 2-chloroprocaine 1% at three intrathecal doses (30, 40 and 50 mg).MethodsAfter informed consent, we enrolled 45 male and female patients, aged 18–65 years, ASA score I-II, BMI 18–32 kg/m2, undergoing elective lower limb procedures lasting ≤40 min and with a requested dermatomeric level of sensory block ≥ T12.The patients were randomised in a 1:1:1 ratio to receive Chloroprocaine HCl 1% at one of the three different intrathecal doses (Group 30 = 30 mg, Group 40 = 40 mg or Group 50 = 50 mg). The progression and regression of both sensory and motor blocks were evaluated blindly. Urine and venous blood samples were collected for pharmacokinetic analysis.ResultsTimes to regression of spinal blocks were 1.76 ± 0.35 h, 2.13 ± 0.46 h and 2.23 ± 0.38 h, in Group 30, 40 and 50 respectively: the 30 mg dose showed a significantly faster resolution of spinal block than the 40 mg (p = 0.034) and the 50 mg (p = 0.006). Time to readiness for surgery was significantly reduced with the dose of 50 mg when compared to dose of 30 mg (p = 0.0259).ConclusionsThe doses of 50 mg and 40 mg yielded a longer resolution of spinal block than the dose of 30 mg. Nevertheless, the dose of 30 mg resulted in a higher secondary failure rate.Trial registrationRegistration of clinical trial: clinicaltrials.gov (NCT02481505).

Posterior quadratus lumborum versus transversus abdominis plane block for inguinal hernia repair: a prospective randomized controlled study

Background and objectivesWe aimed to compare the analgesic effects of both posterior (type 2) Quadratus Lumborum Block (QLB) and Transversus Abdominis Plane Block (TAPB) compared to spinal anesthesia alone for postoperative pain management in inguinal hernia repair. MethodsThis study enrolled 63 patients scheduled for open inguinal hernia repair. The eligibility criteria were undergoing elective unilateral inguinal hernia repair surgery, having an American Society of Anesthesiologists (ASA) physical status I, II, or III, and not suffering from any chronic pain condition. Group S patients received spinal anesthetics and no additional analgesic treatments. Group T patients received TAPB, and Group Q patients received QLB as analgesic technique in addition to spinal anesthetics. ResultsThe pain scores at 6 hours (VAS 6) and 24 hours (VAS 24) were significantly different between groups (p < 0.01). Additionally, the sensory and motor block levels were significantly different between groups (p < 0.05). Multiple comparison tests showed that patients in Group Q had significantly higher sensory and motor block levels (p < 0.01 compared with Group S; p < 0.05 compared with Group T). Opioid consumption was significantly different between Groups Q and S (p < 0.01) after surgery. ConclusionsOur findings show that both blocks are similarly effective for the management of postoperative pain compared to spinal anesthesia alone for inguinal hernia repair. We found that QLB resulted in a significant cranial spread compared to TAPB. Opioid consumption in QLB was significantly lower than that in controls but similar to that in TAPB.

Programmed intermittent epidural bolus for labour analgesia during first stage of labour: a sequential allocation trial to determine the effective interval time between boluses of a fixed volume of 2.5 mL of bupivacaine 0.25% plus fentanyl 8 µg·mL-1.

We studied the programmed intermittent epidural bolus (PIEB) time interval between boluses of 2.5 mL of bupivacaine 0.25% with fentanyl 8 µg·mL-1 to produce effective analgesia in 90% of women (EI90) during the first stage of labour. In a double-blind sequential allocation trial using a biased coin up-and-down design to determine the EI90, the PIEB boluses of 2.5 mL of 0.25% bupivacaine plus fentanyl 8 µg·mL-1 were delivered at varying intervals-60, 50, 40, and 30 min. The primary outcome was the adequate response of the patient to the PIEB regimen, defined as no use of supplemental analgesia for six hours or until the first stage of labour was completed, whichever came first. The secondary outcomes were the upper sensory block level to ice, motor block and hypotension. The isotonic regression with extrapolation approach was used to estimate the EI90. In the 20 women studied, the estimated EI90 was 20 (95% CI, 5.9 to 28.8) min. For the secondary outcomes, we classified women into those assigned to 30 min (16 women) and those assigned to more than 30 min (four women). The median upper sensory block for women in the 30-min group and more than 30 min were T6 (or T5) and T7, respectively. No participants experienced motor block. Hypotension occurred in one patient in the 30-min group. The estimated EI90 for boluses of 2.5 mL of bupivacaine 0.25% with fentanyl 8 µg·mL-1 was 20 (95% CI, 5.9 to 28.8) min. These results suggest that there is no advantage in using this regimen compared with those reported in the literature using the same dose of bupivacaine in concentrations of 0.0625% and 0.125%. www.clinicaltrials.gov (NCT03735771); registered 7 November 2018.

CLONIDINE AS AN ADJUVANT TO HYPERBARIC BUPIVACAINE FOR SPINAL ANESTHESIA IN ELDERLY PATIENTS UNDERGOING INFRAUMBLICAL SURGERIES

Background: Use of adjuvant with small doses of local anesthetics is a preferred technique for spinal anesthesia for lower limb surgeries. This study tested the hypothesis that addition of small doses of clonidine augments the spinal block levels produced by hyperbaric bupivacaine in patients without affecting the side-effects. Materials and Methods: This was a prospective, randomized, double-blind study. Above 60 years patients were allocated to three equal groups. Group C received 10 mg hyperbaric bupivacaine without clonidine while Group C and Group C received 15 μg and 30 μg clonidine with 15 30 hyperbaric bupivacaine respectively for spinal anesthesia. Effect of clonidine on sensory block levels was the primary study outcome measure. Motor blockade and hemodynamic parameters were also studied. Results:Asignicantly higher median block levels were achieved in Group C (P &lt; 0.05) and Group C (P &lt;0.05) than Group C. Highest median 15 30 sensory block level, the mean times for sensory regression to T12 level and motor block regression were statistically signicant between Groups C15 and C and between Groups C and C. On comparison of fall in systolic blood pressure trends, there was no signicant difference in the clonidine 30 groups as compared with the control group. Conclusions: In elderly patients, clonidine when used intrathecally in doses of 15 μg or 30 μg with bupivacaine, signicantly potentiated the sensory block levels and duration of analgesia without affecting the trend of systolic blood pressure as compared to bupivacaine alone. Clonidine in doses of 30 μg however facilitated the ascent of sensory level block to unexpectedly higher dermatomes for a longer time.

Comparison of Intrathecal Dexmedetomidine and Fentanyl as Adjuvants to Hyperbaric Bupivacaine: A Randomised Controlled Trial

Introduction: Subarachnoid block using bupivacaine along with fentanyl is routinely used in regional anaesthesia technique in lower limb and lower abdominal surgeries. However, fentanyl is often associated with various side effects. The use of dexmedetomidine as an alternative to fentanyl in regional blocks is emerging due to minimal adverse effects and prolonged duration of action. Aim: To compare intrathecal dexmedetomidine and fentanyl as adjuvants to hyperbaric bupivacaine. Materials and Methods: The prospective, randomised study was performed on 100 patients, divided into two groups. Group I patients were administered with bupivacaine 12.5 mg (2.5 mL)+ fentanyl 25 μg (0.5 mL) whereas group II patients received bupivacaine 12.5 mg (2.5 mL) + dexmedetomidine 5 μg (0.5 mL). Post anaesthesia Heart Rate (HR) and Blood Pressure (BP) were recorded. The onset of sensory and motor block, level of sensory block, time for two segment regression, motor and sensor recovery, duration, quality of analgesia and Visual Analog Scale (VAS) score were recorded. Data were analysed using R Studio V 1.2.5001 software. Wilcoxon signed rank test and independent sample t-test were used to find the difference between mean. The p&lt;0.05 was considered statistically significant. Results: Time for onset of sensory block (p=0.0027), motor block (p&lt;0.001) and peak sensory block (p&lt;0.001) was significantly high in group I patients. Most of the patients of group I had a T8 level of sensory block (38%) while in group II around 36% of patients had T6 level of sensory block. Time for full motor recovery (p=0.0015) and sensor recovery (p&lt;0.001) was high in group II patients. Conclusion: Dexmedetomidine is associated with long term motor and sensory block, excellent analgesia and there was less demand for rescue analgesics as compared to fentanyl.

Comparison of the effects of intravenous fluids and vasoconstrictive agents on the hemodynamic response developing in spinal anaesthesia

Aim: The study’s aim was to compare the effects of norepinephrine, ephedrine, and 0.9% sodium chloride (NaCl) solution against the hemodynamic response that develops after spinal anaesthesia.Materials and Methods: The study was conducted on 80 patients who were scheduled for surgery onlower extremity varicose veins, and they were divided into four groups. Group F was started with a 0.9% NaCl solution of 15ml/kg 20 minutes before spinal anaesthesia. For 20 minutes after spinal anaesthesia, Group E received 2mg/min of ephedrine and Group N received 5mic/min norepinephrine as an infusion. Meanwhile, Group C was not given any medication or fluid. Spinal anaesthesia was performed with 0.5% bupivacaine. The systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and peripheral oxygen saturation (SPO2) values of the patients were recorded before and after the procedure. Sensorial block levels and degrees of motor block were also recorded after the operation. In addition, side effects other than hypotension that may develop after the surgery were also recorded.Results: There was no statistically significant difference between the groups in terms of SBP, DBP, SPO2, HR, sensory block level, and degree of motor block (p>0.05). In Group C, the decrease in SBP and DBP values that occurred at the fifteenth, twentieth, and thirtieth minutes of spinal anaesthesia was statistically significant when compared with the control values (SBP: p=0.0274, 0.0028, 0.0036, and DBP: p=0.0132, 0.0210, 0.0041). Hypotension developed in 10 (50%) of the 20 patients in Group C, and a 10mg intravenous (IV) bolus intervened with ephedrine. This result was statistically significant when compared with Group F, Group E, and Group N (p=0.005).Conclusion: As a result, it has been shown that norepinephrine, ephedrine, and 0.9% NaCl solution are similarly effective in preventing hypotension from developing after spinal anaesthesia.

Comparative effects of dexmedetomidine and fentanyl as adjuvants to hyperbaric bupivacaine in elective caesarean sections: an observational study at tertiary care centre

Aim: The aim of the present study to compare the effects of Dexmedetomidine and fentanyl as adjuvants to hyperbaric bupivacaine in elective ceasearen sections. Methods: This prospective study was done in the Department of anaesthesiology, LD hospital an associated hospital of GMC, Srinagar, India from December 2019 to November 2020. The participants included 130 parturient with gestational age ≥37 weeks and ASA I and II candidates for elective caesarean section under spinal anesthesia were included in this study. All 130 patients were randomly and equally divided into the following two groups: Group B-D received 10 mg hyperbaric bupivacaine 0.5%+10 μg dexmedetomidine. Group B-F received 10 mg hyperbaric bupivacaine 0.5%+25 μg fentanyl. Hemodynamic monitoring including SBP and DBP, mean arterial pressure (MAP), heart rate (HR) and peripheral oxygen saturation level (SpO2) were recorded. Patient’s pain score was assessed using visual analogue scale (VAS); scored from 0–10 (where 0=no pain and 10=the worst pain imaginable) during the recovery room (T0) and at one, three, and six hours (T1, T3, and T6) in the postoperative period. If the VAS score was more than 3, a rescue dose of tramadol (100 mg) was administered intravenously. Results: The mean dose of mephentermine in the B-D and B-F groups were 5.45±6.74 and 6.79±5.69mg, respectively. The Mann–Whitney test showed that there was no significant difference between the two groups (P=0.78). With respect to the bradycardia, the mean dose of atropine in the B-D and B-F groups were 0.12±0.28 and 0.06±0.15 mg, respectively. According to the Mann–Whitney test, in this regard, no significant difference was seen between the two groups. (P=0.32). The results of the Mann–Whitney U-test indicated that the onset of block in the B-D group (97.88±32.78 seconds) was significantly faster than in the B-F group (112.03±36.68 seconds) (P=0.041). Considering the level of sensory block, T4 level was shown in 81 (62.31%) patients, from whom 47 (58.02%) and 34 (41.98%) patients were in the B-D and B-F groups, respectively. Moreover, T6 level was observed in 49 (37.69%) patients, from whom 19 (38.78%) and 30 (61.22%) patients were in the B-D and B-F groups, respectively. Chi-squared test revealed that there was no statistically significant difference between the two groups (P=0.13). Conclusion: Compared with fentanyl, it seems that adding 10μg dexmedetomidine to bupivacaine has a better effect on postoperative pain management in cesarean section under spinal anesthesia.

Вариант анестезии при операциях тотального эндопротезирования суставов нижних конечностей

In this study we sought to optimize analgesia in total joint arthroplasty of the lower extremity and reduce the risk of arterial hypotension in patients with various degrees of obesity. The optimization contributed to the development of a new technique of spinal anesthesia. The technique leads to the epidural volume extension, as well as the decrease of local anesthetic doses administered into the subarachnoid space and saving the level of sensory block. The aim of the study was to study the effect of the spinal anesthesia with the epidural volume extension technique on the level of sensory block and hemodynamics in patients with various degrees of obesity during total arthroplasty of the lower extremity joints for III stage osteoarthritis. The prospective single-center study included 103 patients (79 men (76.7%), mean age 59±11 years, range from 33 to 74 years) who were treated in the Department of Traumatology and Orthopedics from September 2019 to May 2020. Anthropometric parameters, levels of sensory and motor blocks, level of pain syndrome, sympathetic block, duration of surgery and anesthesia were analyzed. To assess the impact of all factors on the outcome, methods of one-dimensional analysis with the calculation of relative risk (RR) were used. All patients were divided into two groups: the control group (combined spinal-epidural anesthesia was used) and the main group (spinal anesthesia with epidural volume extension was used). The average upper level of the sensor block (Th-segment) at 15 minutes after spinal anesthesia did not significantly differ in the groups (p=0.95). Differences in the frequency of hypotension in the groups were not statistically significant (p˃0.05). RR: 1.17 [95% CI: 0.794; 1.726]. Reducing the dose of a local anesthetic by 25% to provide adequate spinal anesthesia with the epidural volume extension in patients with a high body mass index achieves the same result when assessing sensory, motor and sympathetic blockages when compared with the traditional method of anesthesia.

Maternal hypotension and fetal outcome: effect of height-adjusted and weight-adjusted dose versus fixed dose of 0.5% intrathecal hyperbaric bupivacaine

Background Profound hypotension during cesarean section can compromise fetal circulation and cause cardiac arrest in the parturients. We compared the incidence of hypotension, adequacy of anesthesia, and neonatal outcome using a height-adjusted and weight-adjusted dose and a fixed dose of 0.5% intrathecal hyperbaric bupivacaine. Patients and methods This was a randomized controlled double-blind trial involving 80 parturients aged 18–40 years scheduled for elective cesarean section under spinal anesthesia. They were randomly allocated by blind balloting into one of two groups: group FD received 12 mg of 0.5% hyperbaric bupivacaine, whereas group AD received a height-adjusted and weight-adjusted dose of 0.5% hyperbaric bupivacaine according to Harten’s chart. Parturients were preloaded with 10 ml/kg of 0.9% sodium chloride. Results The median dose of bupivacaine was significantly higher in group FD (12 mg) than group AD (9.5 mg) (P=0.001). The incidence of hypotension was significantly higher in group FD (60%) than in group AD (32.5%) (P=0.014). The median time to attain the maximal level of sensory block (T5) was significantly faster in group FD (10 min) than group AD (13 min) (P=0.021). The Apgar score and incidences of other complications were comparable between both groups (P>0.05). Conclusion It is concluded that a lower dose of bupivacaine was required to provide comparable sensory and motor block, with less incidence of hypotension when the bupivacaine dose was adjusted to the height and weight of parturients than when a fixed dose was used.

Efficacy of Different Doses of Intrathecal Chloroprocaine as Anaesthetic for Ureterorenoscopic Lithotripsy

Background amp Aims Ureterorenoscopic URSL surgeries for ureteric calculus are frequently done under spinal anaesthesia SA. Bupivacaine use related prolonged action and lignocaine caused transient neurological deficits prompted us to study preservative free 1 chloroprocaine a short acting local anaesthetic for URSL.Methods In this observational study after Institutional Ethics Committee approval 105 patients of either sex of ASA I and II in the age group of 18 to 60 years undergoing URSL under SA were enrolled. The subjects were to receive intrathecal chloroprocaine 40 45 and 50 mg respectively Group AB amp C. With monitoring and crystalloid preloading the study drug was given intrathecally. Haemodynamics sensory and motor blocks were assessed as per protocol along with procedure related complications and were documented. Data was analysed using ANOVA and post hoc analysis by Bonferroni test with stata version 14. p value lt0.05 was considered statistically significant.Results The three groups were comparable demographically and for surgical duration. The onset peak sensory block level onset of motor block perioperative haemodynamics were comparable between the groups p gt0.05. Group C had prolongation of sensory motor blockade 100.14plusmn6.58 min amp 86.14plusmn3.85 min and needed more time 140.14plusmn10.56 min for complete recovery of sensory blockade and discharge compared to group A and B which was statistically significant plt0.001.Conclusions 1 chloroprocaine can be safely administered intrathecally for URSL in dose range of 40-50 mg

Evaluation of the effect of intravenous dexmedetomidine on characteristics of spinal anaesthesia with hyperbaric bupivacaine

Aims: A study was performed to evaluate the effect of intravenously administered dexmedetomidine just before spinal anaesthesia, on spinal block characteristics, postoperative analgesia, haemodynamics and sedation. Methods: Sixty patients, aged 18 - 50 years of either sex, ASA grade I & II, who were undergoing elective lower abdominal and lower limb surgeries under spinal anaesthesia with hyperbaric bupivacaine, were randomly allocated in to two equal groups of 30 patients each to recieve 20 ml of normal saline intravenously (group A) and intravenous dexmedetomidine 0.5 mcg/kg prepared in normal saline to a total volume of 20 ml (group D) over a 10 min period as a single dose just before spinal anaesthesia. Onset and duration of sensory blocks and motor blocks, highest sensory block level, time to 2 segment regression, duration of analgesia, perioperative haemodynamic parameters, VAS and sedation scores were assessed. Results: Both groups were comparable with regard to demographic data. The onset of sensory and motor block were significantly earlier in group D as compared to group A. Duration of motor block and analgesia were significantly longer in group D as compared to group A. Sedation score were significantly higher in group D. Though HR and NIBP were significantly decreased in group D, however all patients remained haemodynamically stable. Conclusion: Bolus dose of intravenous dexmedetomidine 0.5 µg/ kg administered just before spinal anaesthesia prolongs the duration of sensory – motor block and postoperative analgesia with arousable sedation.

Clinical utility of epidural volume extension following reduced intrathecal doses: a randomized controlled trial

Background and objectivesEpidural Volume Extension (EVE) involves instillation of normal saline into the epidural space soon after an intrathecal injection, with the aim to augment the sensory block height. Its clinical relevance lies in the possibility of using reduced intrathecal dose and yet achieving the desired sensory block level. Intrathecal dose is a known determinant of the level of sensory block. Whether EVE is dependent on intrathecal dose is not known. MethodsWe conducted a randomized, controlled, double-blind study to compare the maximum sensory level (Smax) achieved with or without application of EVE to two different reduced intrathecal doses. Eighty four adult male patients of ASA status I or II with body weight between 50–70kg and height in the range of 150–180cm, scheduled for orthopedic lower limb surgery using combined spinal epidural anesthesia were randomized to receive, either intrathecal dose (5 or 8mg) with or without EVE, in accordance to group allocation. ResultsSmax was lowered by application of EVE to 5mg intrathecal bupivacaine (T8.9±4.3 vs. T6.4±1.9 with and without EVE respectively; p = 0.030). Smax was similar when EVE was applied to 8mg intrathecal bupivacaine than without it (T5.8±1.8 vs. T6.4±2.2 respectively; p= 0.324). ConclusionEVE should not be applied to 5mg plain bupivacaine during a combined spinal epidural block in patients undergoing lower limb orthopedic surgery as it may result in a decrease in the maximum sensory level.

Programmed intermittent epidural boluses (pieb) for labor analgesia: study of the sensor block and effects on maternal motor function

Background. Programmed intermittent epidural boluses (PIEB) technique is a promising approach that demonstrates certain advantages over traditional techniques of epidural analgesia. We compared the dynamics of the sensory block of PIEB + parturient-controlled epidural analgesia (PCEA) with continuous epidural infusion (CEI) + PCEA for maintenance labor analgesia and the incidence of motor block (MB) in women who received PIEB or traditional techniques.&#x0D; Methods. A total of 165 subjects were studied. All parturients were divided into five groups: manual boluses, PCEA, PCEA + CEI, PIEB + PCEA; levobupivacaine 0.25 mg/mL; 1.25 mg/mL; 0.625 mg/mL. The level of the MB was evaluated by the classic Bromage scale (0-1-2-3). The level of the sensor block was evaluated by the pin-prick test.&#x0D; Results. MB was reported in 80% in group 1 120 min after analgesia, 78% and 52% in groups 2 and 3 at the 150th min (p 0.001); in group 4, the MB frequency was 6% 15 min after the start and was increasing to 40% at full cervical dilation (p 0.001). In group 5, the relative MB frequency did not exceed 10% at the 120th min and was 0% at full cervical dilation (p 0.00001). The results indicate that in the PIEB group, the level of sensory block in patients was higher 15 min after the start of analgesia and remained so until the end of the observation period [median PIEB Th5 versus Th8 in the CEI group, (p 0.0004)].&#x0D; Conclusions. PIEB + PCEA technique maintained a consistently high level of sensor block throughout the study compared to PCEA + CEI, which ensured effective analgesia in the first and second stages of labor with minimal MB.