Longer Duration Of Postoperative Analgesia Research Articles

Assessment of the Efficacy of Nalbuphine as an Adjuvant to Intrathecal Bupivacaine in Endoscopic Urological Surgeries for the Prolongation of Postoperative Analgesia.

Background In anaesthesiology, intrathecal drugs play pivotal roles in spinal anaesthesia. Despite their ability to induce a high sensory block, bupivacaine alone may not be adequate for postoperative analgesia. It often requires a substantial dose of postoperative rescue analgesia to manage pain effectively. Thus, we studied the efficacy of nalbuphine 1.5 mg injected intrathecally as an adjuvant in endoscopic urological surgery. Materials and methods Sixty patients undergoing endoscopic urological surgery were equally divided into two study groups: group B (injection 0.5% hyperbaric bupivacaine 15 mg (3 ml) plus sterile NS 0.15 ml) and group N (injection 0.5% hyperbaric bupivacaine 15 mg (3 ml)+nalbuphine 1.5 mg (0.15 ml)). The first appearance of the sensory and motor blockages and duration required to attain complete sensory and motor threshold was noted. All vitals were recorded. After surgery, it was recorded when the patient first needed rescue analgesia (injection paracetamol 1 gm IV). Any adverse effects were recorded and addressed. The statistical analysis was conducted using IBM SPSS Statistics for Windows, V. 22.0 (IBM Corp., Armonk, NY), with p<0.05 indicating significance in both groups' operations. Results Intrathecal nalbuphine as an adjuvant caused an earlier onset of sensory and motor inhibition, delayed two-segment regression, and prolonged postoperative anaesthesia. The control group experienced sensory block at 3.33±0.61 minutes, while the nalbuphine group had a mean onset of 2.66±0.92 minutes (p=0.001). The patient who received nalbuphine had a mean regression time of 119.60±14.549 minutes, whereas the bupivacaine group had a mean regression time of 88.43±17.196 minutes. Group N had a considerably longer duration of postoperative analgesia, lasting 264.97 minutes, compared to group B's 198.50 minutes (p<0.001). Intrathecal nalbuphine did not influence vital indicators such as heart rate, respiration rate, and oxygen saturation. Conclusion To conclude, endoscopic urological surgery patients who received a subarachnoid block with 1.5 mg (0.15 ml) of nalbuphine hydrochloride with 0.5% hyperbaric bupivacaine 15 mg (3 ml) had longer postoperative pain relief than those who received 3 ml of intrathecal bupivacaine (15 mg). Urinary retention and pruritus were absent. Intrathecal nalbuphine with hyperbaric 0.5% bupivacaine is deemed safe with minimal side effects in endoscopic urology surgery.

Fentanyl versus Magnesium Sulfate with 0.5% Ropivacaine in Adductor Canal Block for Knee Surgeries

Abstract Background: Adductor canal block (ACB) is an emerging technique for postoperative analgesia following knee surgery. ACB technique is relatively easy and is performed under ultrasound guidance. Aims: This study aimed to compare the efficacy of fentanyl and magnesium sulfate as adjuvants with 0.5% ropivacaine in ACB for patients undergoing knee surgeries. Adverse events if any were also noted. Materials and Methods: The study was conducted on 100 patients aged 40–80 years posted for knee surgeries. They were divided into two groups of 50 each: Group ropivacaine with fentanyl (RF) and Group ropivacaine with magnesium (RM). Group RF received 30 mL of 0.5% ropivacaine with 50 μg of fentanyl. Group RM received 30 mL of 0.5% ropivacaine with 125 mg of magnesium sulfate. Both the groups were compared on the basis of time for the first rescue analgesia given after the block. The results were analyzed using the SPSS software. Results: The mean time of the first rescue analgesia was 8.40 ± 0.85 h in Group RF and 10.63 ± 1.10 h in Group RM, which was higher and statistically significant (P = 0.002). Rescue analgesia was given more frequently in Group RF (5.77±3.84) compared to group RM (3.20±1.27) and this was statistically significant (P = 0.000). There were no significant adverse events noted in both the groups. Conclusion: Both the adjuvants, when added to ropivacaine, prolong the duration of blockade and reduce the requirement of rescue analgesia without causing significant adverse effects, but magnesium sulfate has an extra edge over fentanyl in terms of longer duration of postoperative analgesia.

A comparative evaluation of 0.75% ropivacaine with fentanyl versus 0.75% ropivacaine with dexmedetomidine in intrathecal anesthesia for lower limb surgeries

Background: Anesthesia for lower limb surgeries can be administered locally, regionally (spinal or epidural), or generally. The primary option is still spinal anesthesia because of its quick onset, excellent blockage, low infection risk, low failure rate, and affordability. The most widely utilized method is bupivacaine spinal anesthesia. By extending and strengthening the sensory blockade, an adjuvant not only boosts the effectiveness of a local anesthetic but also lowers the dosage of local anesthetic drugs. Aims and Objectives: The aims and objectives of the study are to assess the synergistic effect and safety of adding dexmedetomidine to ropivacaine 0.75% in the subarachnoid block for lower limb surgeries compared to fentanyl to ropivacaine 0.75%. Materials and Methods: The present study was a prospective randomized control study, carried out at the Department of Anesthesiology and Critical Care, Kempegowda Institute of Medical Sciences, Bangalore, for a period of 2 years. Two groups of 30 subjects each were selected for the study by simple random sampling. Patients with physical status ASA 1 or 2 who underwent elective lower limb surgeries were included. Patients in Group F (n = 30) received 3 mL of isobaric 0.75% ropivacaine and 25 μg fentanyl (0.5 mL) and in Group D (n = 30) received 3 mL of isobaric 0.75% ropivacaine with 10 μg dexmedetomidine (0.5 mL). Sensory testing was assessed by loss of pinprick sensation. The motor block in the lower limb was graded according to the modified Bromage scale. Duration of analgesia was noted. Hemodynamic parameters were recorded every 5 min for 1st 30 min and thereafter every 30 min till the patient complained of pain. Results were analyzed using the SPSS 20.0 version and the association was tested using Student t-test and Chi-square test. Results: The average time for sensory block onset was 2.93 ± 0.25 min in Group D and 2.43 ± 1.14 min in Group F. In both Group D and Group F, the length of the sensory block was 281.33 ± 25.15 and 144.67 ± 19.43, respectively, and was extremely significant both statistically and clinically. When compared to Group F, which had analgesia for 144.67 ± 19.43 min, Group D experienced analgesia for a significantly longer duration, 360.67 ± 16.17 min. There was a statistically significant difference (&lt;0.001). In Group D, the average motor block duration was 339.67 ± 19.21 min, whereas in Group F, it was 92.33 ± 16.95 min. Conclusion: When compared to fentanyl as an adjuvant to ropivacaine, intrathecal dexmedetomidine causes a faster onset of sensory and motor blockade and a longer duration of motor and sensory block, as well as hemodynamic stability, higher sedation, and a longer duration of post-operative analgesia.

To evaluate the analgesic efficacy of intravenous dexamethasone as an adjuvant to caudal block: A prospective, randomized, double-blind study

Background: Post-operative pain is of great concern in pediatric age group. Intravenous dexamethasone has been found to be promising in reducing post-operative pain when administered as an adjuvant to epidural anaesthesia in abdominal and orthopedic surgeries. However, little is known about its efficacy in children receiving caudal block for post-operative pain relief. Aims and Objectives: This study aimed to evaluate the analgesic efficacy of intravenous dexamethasone as an adjuvant to caudal block in children posted for infraumbilical surgeries. Materials and Methods: This interventional, double-blinded, randomized controlled study included 110 children aged 1–5 years with American Society of Anesthesiologists Grade I and II undergoing elective infraumbilical surgeries. To test our hypothesis, the superiority of intravenous dexamethasone was compared with the control group. All children received caudal bupivacaine 0.25% (1 mL/kg). Children were randomly allocated to two groups to receive: normal saline 0.075 mL/kg (Group C) and IV dexamethasone 0.3 mg/kg (0.075 mL/kg) (Group D). Post-operative pain scores (Face, Legs, Activity, Cry, and Consolability [FLACC] score), duration of analgesia, post-operative analgesic consumption, and intraoperative hemodynamics were compared. Results: FLACC score was found to be higher in Group C than Group D at all times. The mean FLACC score was significantly less with the study drug compared to the control group (P&lt;0.001). The time to request for first rescue analgesia was significantly less in Group C as compared to Group D (4.01±0.69 h vs. 5.51±0.50 h, P=0.019). The mean total analgesic consumed in the first 24 h was significantly higher in Group C than in Group D (666.09±174.69 mg vs. 384.55±125.04 mg, P=0.015). Hemodynamic parameters were comparable in both the groups. Conclusion: Intravenous administration of dexamethasone 0.3 mg/kg as an adjunct to caudal bupivacaine 0.25% provides significantly longer duration of post-operative analgesia and lesser total analgesic consumption compared to the use of caudal bupivacaine 0.25% alone.

Ultrasound-Guided Pericapsular Nerve Group Block for Hip Surgery: A Randomized Controlled Trial Study Comparing Ropivacaine and Ropivacaine With Dexamethasone.

Patients with hip fractures will be experiencingexcruciating pain, which would preventthe ideal positioning of the patient for the neuraxial blockade. There is growing interest in using regional nerve blocks for pain in the elderly associated with a fractured hip. Pericapsular Nerve Group (PENG) block is gaining popularity as a provider of adequate analgesia in patients suffering from a hip fracture. The present study aimed to assess the effectiveness of PENG block using ropivacaine alone or ropivacaine with dexamethasone in reducing pain scores during patient positioning for the central neuraxial blockade and to compare the duration of postoperative analgesia. This randomized double-blinded study was conducted on patients posted for hip surgery under spinal anesthesia at a tertiary care referral hospital between January 2021 and May 2022. Twenty-eight patients (14 in each group) were randomly allocated to receive either group A (20 ml of 0.5% ropivacaine for PENG block) or Group B (20ml of 0.5% ropivacaine with 8mg Dexamethasone for PENG block) before patient positioning for subarachnoid block. Intra-operative hemodynamic variables, pain scores on a visual analog scale (VAS), at rest and with movement, before block, at the time of positioning for spinal anesthesia, time for first rescue analgesic request, and the total dosage of rescue analgesia in the first 24 hours after PENG block were measured. Pain scores at rest and with movement at baseline and at the time of positioning for spinal anesthesia were significant within the groups (p< 0.01). The time for the first rescue analgesic requirement was significantly longer in group B (445.0 ±17.4 minutes) than in group A (388.9±19.0 minutes) (p<0.05). The mean average number of doses of rescue analgesia (Tramadol in milligrams) was significantly lower in group B (190 ± 60) than in group A patients (250 ± 70) (p<0.05). The present study documented the effectiveness of PENG for patient positioning during the neuraxial blockade. Further, the addition of dexamethasone as an adjunct to ropivacaine yields a significantly longer duration of postoperative analgesia with a lowerpostoperative analgesic requirement.

Effect of Isobaric Levobupivacaine and Fentanyl versus Isobaric Ropivacaine and Fentanyl as an Adjuvant in Patients Undergoing Transurethral Resection of the Prostate: A Randomised Clinical Study

Introduction: Ropivacaine is a newer local anaesthetic proven to have a lower systemic toxicity profile, particularly in terms of cardiac and Central Nervous System (CNS) toxicity, than the racemic and levorotatory isomers of bupivacaine, especially in elderly patients. Fentanyl, as an adjuvant, enhances analgesia and promotes early postoperative mobility. Aim: To assess and compare the efficacy and safety of isobaric levobupivacaine and fentanyl versus isobaric ropivacaine and fentanyl in patients undergoing Transurethral Resection of the Prostate (TURP) under Spinal Anaesthesia (SA). Materials and Methods: A randomised clinical study was conducted in the Department of Anaesthesia at SMS Medical College and Attached Hospitals, Jaipur, Rajasthan, India, from March 2021 to January 2023. A total of 60 patients ranging in age from 40 to 80 years, scheduled for elective TURP, were enrolled in the present study. The selected patients were randomly assigned into two groups, each consisting of 30 patients. Group A received a dosage of 2.6 cc of 0.75% isobaric ropivacaine (equivalent to 19.5 mg) along with 0.4 cc of fentanyl (equivalent to 20 micrograms). In contrast, group B received a dosage of 2.6 cc of 0.5% isobaric levobupivacaine (equivalent to 13 mg) and 0.4 cc of fentanyl (20 micrograms). The primary outcome measures were the onset of action, duration of sensory-motor block, and postoperative analgesia. Data were analysed using Epi Info version 7.2.1.0 statistical software. The quantitative data collected were summarised using the mean and Standard Deviation (SD). A p-value of less than or equal to 0.05 was considered statistically significant. Results: The majority of patients in the present study were elderly males in both groups. The mean age distribution in group A was 64.27±8.17, and in group B, it was 65.13±7.1. Both groups were comparable and not statistically significant (p=0.634). The mean weight of the two groups was similar, with group A at 64.9±7.49 kg and group B at 63.1±6.96 kg. Both groups were comparable and not statistically significant (p=0.334). The mean height of the patients was 165±4.85 cm in group A and 164±3.83 cm in group B, and it was comparable between the two groups without statistical significance (p=0.145). The duration of sensory block was 241.03±18.88 minutes in group A and 181.5±33.42 minutes in group B. The duration of motor block was 210.7±17.93 minutes in group A and 160±14.82 minutes in group B. Group A demonstrated a significant prolongation of sensory (p&lt;0.001) and motor (p&lt;0.001) block, as well as postoperative analgesia, when compared to 0.5% levobupivacaine with fentanyl. Conclusion: The requirement for rescue analgesia occurred earlier in the levobupivacaine group. Therefore, the use of ropivacaine with fentanyl for spinal anaesthesia in TURP cases is a superior alternative compared to levobupivacaine with fentanyl, as it provides satisfactory quality and duration of block, as well as a longer duration of postoperative analgesia, as assessed by the Visual Analogue Scale (VAS) score and Modified Bromage score.

Comparative study between the use of bupivacaine alone or with nalbuphine in ultrasound-guided supraclavicular brachial plexus block for upper limb surgeries

Background Brachial plexus block is a well-studied method of providing reliable anesthesia or analgesia for the upper extremity. Many approaches for brachial plexus block are present. These approaches are classified according to the level of local anesthetic injection into interscalene, supraclavicular, infraclavicular, and axillary blocks. By providing a rapid onset of dense anesthesia of the arm with a single injection, the supraclavicular block is perfect for operations involving the arm and forearm, from the distal humerus down to the hand. Ultrasound guidance has resulted in a better practice of supraclavicular approach to the brachial plexus, with decreasing the risk of complications. There has always been a search for adjuvants to local anesthetics used in regional nerve block with drugs that prolong the duration of analgesia but with lesser adverse effects. Objective To compare the effect of nalbuphine as an additive to bupivacaine versus bupivacaine alone in supraclavicular brachial plexus block with ultrasound guidance in upper limb surgeries regarding onset and duration of sensory and motor blocks, duration of analgesia, and postoperative analgesic requirements, as well as the effects on hemodynamics and possible complications with each technique. Patients and methods This study was carried out in Alexandria Main University Hospital on 50 adult patients of both sexes, American Society of Anesthesiology I and II, scheduled for surgeries of the hand and forearm under supraclavicular brachial plexus block with ultrasound guidance. Patients were randomly categorized into two equal groups (25 patients each) using the sealed envelope technique. Group I patients received bupivacaine only for the block, and group II patients received bupivacaine and nalbuphine as an adjuvant for the block. Results The results of our study showed that patients in nalbuphine group (group II) had significantly longer sensory and motor blocks duration, with longer duration of postoperative analgesia, when compared with patients in group I, who were received bupivacaine only for the block. Conclusion Coadministration of nalbuphine with bupivacaine in supraclavicular brachial plexus block leads to a significant increase in the duration of sensory and motor blocks and provides prolonged postoperative analgesia without causing adverse hemodynamic instability.

A Comparative Evaluation of Dexmedetomidine vs Clonidine used as Adjuvants with Hyperbaric Bupivacaine in Patients with Preeclampsia Undergoing LSCS

Relief of operative as well as post operative pain should be the prime responsibility of an anesthesiologists. The most common treatment for post operative pain remains conventional intramuscular injection of narcoticswhich are associated with several side effects like nausea, vomiting, itching, hypotension, bradycardia,urinary retention, dysphoria,respiratory depression, early and later. Pregnancy induced hypertension is a major cause of morbidity and mortality in obstetrics, complicating 3-8% of pregnancies. Severe preeclampsia poses a dilemma for anesthesiologists, and there is some controversy about the best anaesthetic technique for caesarean delivery in such cases. Though spinal anasthesia reduces the risk of airway instrumentation in high risk patients of preeclampsia, there are still limitations about its limited duration of analgesia. In present study we intend to compare dexmedetomidine and clonidine used with hyperbaric bupivacaine for spinal anaersthesiain patients with preeclampsia undergoing LSCS. Primary Objective: To compare the clinical efficacy of intra the caldexmedetomidine vs Clonidine on: (a) Onset and duration of sensory block (b) Onset and duration of motor block (c) Duration of analgesia (d) Side effects if any. Secondary Objective: to compare the haemodynamic profile among patients of the two group. Methodology: All eligible patients were randomly assigned into two groups of 50 each by chit and envelope method: Group A: SAB was given with 2ml, 0.5 % Bupivacaine(H) + 45 µg Clonidine. Group B: SAB to be given with 2ml, 0.5% Bupivacaine (H) + 5µg dexmedetomidine. Results: Regression of sensory block was prolonged in group B as compared to group A.(p value &lt;0.0001). There was regression of motor block in group B as compared to group A. p value&lt;0.0001Heart rate remained stable and comparable at different time points in 2 groups. Except three patients in group A and one patient in group B, no other patient in either group developed bradycardia. Three patients in group A and in group B developed hypotension which responded to intravenous fluid therapy. Sedation score decreased to 0 within 5 hours. At no time, sedation score exceeded 2 and no patient developed signs of respiratory depression. Conclusion: Dexmedetomidine in the dose of 5µg added to 10 mg 0.5% Hyperbaric Bupivacaine in SAB for LSCS surgery in parturients with preeclampsia provides comparable onset for sensory and motor blockade but significantly prolonged duration as compared to 45µg of clonidine. Longer duration of postoperative analgesia with 5µg Dexmedetomidine makes it superior to clonidine in respect to postoperative analgesia. Both the drugs produce desirable level of intraoperative and postoperative sedation, stable hemodynamics and minimal side effects.

A Comparison of Analgesic Effect of Different Doses of Intrathecal Nalbuphine Hydrocloride with Bupivacaine and Bupivacaine alone for Lower Abdominal and Orthopedic Surgeries

Objective: To compare the analgesic effect of different doses of nalbuphine when added to bupivacaine in spinal anaesthesia. To compare the onset of sensory blockade (time taken form 3, 5 min and then every 5 min until the end of the procedure. Methods: 100 ASA grade 1 and 2 patients grouped into group A, group B, group C and group D randomly. Age group of 18-60 years. Patient undergoing elective lower abdominal and orthopedic surgery received with Group A : included 25patients with 0.5% hyperbaric bupivacaine 3 cc (15mg) + N.S. 0.2 ml. Group B: included 25 patients with 0.5% hyperbaric bupivacaine (3 cc) 15 mg + 0.8mg nalbuphine + N.S. 0.2 ml. Group C: included 25 patients with 0.5% hyperbaric bupivacaine (3 cc) 15 mg + 1.6mg nalbuphine + N.S. 0.2 ml. Group D: included 25 patients with 0.5% hyperbaric bupivacaine (3 cc) 15 mg + 2.4 mg nalbuphine + N.S. 0.2 ml. Results: The mean sensory onset of study subjects in group A, B, C and D were 8.4±0.5, 5±0.9, 5.6±1 and 8.2±1.4 respectively and this difference was statistically significant. The mean motor onset of study subjects in group A, B, C and D were 10.2±0.7, 6.8±0.9, 6.1±1.2 and 8.6±1.1 respectively and this difference was statistically significant. The mean sensory duration of study subjects in group A, B, C and D were 176.8±29.3, 282±6.8, 300.2±6.6 and 286.2±9.8 respectively and this difference was statistically significant. The mean time for maximum sensory level of study subjects in group A, B, C and D were 11.5±1, 8.8±0.8, 5.6±1.6 and 8.2±1.2 respectively and this difference was statistically significant. The mean T 10 time of study subjects in group A, B, C and D were 8.5±0.5, 8.7±0.7, 5.6±1.6 and 8.6±1 respectively and this difference was statistically significant. The mean time for 2 segment regression of study subjects in group A, B, C and D were 76.6±2, 92.2±2.3, 95.8±3 and 90.6±4.4 respectively and this difference was statistically significant. The mean motor duration of study subjects in group A, B, C and D were 179.8±8.9, 184.6±6, 203.2±7 and 187±9.9 respectively and this difference was statistically significant. The mean analgesic duration of study subjects in group A, B, C and D were 175.8±4.1, 271.1±7.8, 303.8±9.9 and 279±10.7 respectively and this difference was statistically significant. Conclusion: We came to conclusion that 0.5% hyperbaric bupivacaine (15mg) with nalbuphine (0.8mg, 1.6 mg, 2.4 mg) in subarachnoid block. Therefore addition of 1.6 mg nalbuphine to 15mg of 0.5% hyperbaric bupivacaine 15 mg in subarachnoid block can be considered safe with minimum complication, and provides excellent quality and longer duration of postoperative analgesia with good sedation compared with 0.8 mg and 2.4 of nalbuphine. So it is useful for prolonged duration of postoperative analgesia.

A Comparative Study of the Efficacy of Intrathecal Plain Bupivacaine Hydrochloride and Bupivacaine Hydrochloride with Fentanyl Citrate in Lower Segment Caesarean Section

Background: Neuraxial administration of opioids with local anaesthetics improve the quality of intraoperative analgesia. It is also known to produce a longer duration of postoperative analgesia. The purpose of this study was to compare the efficacy of intrathecal plain bupivacaine with bupivacaine and fentanyl combination in patients who undergo a lower segment caesarean section.

Postoperative Analgesic Effect of Morphine Added to Ropivacaine for Fascia Iliaca Compartment Block following Femoral Fracture Surgeries: A Randomized Controlled Trial

Background: Fascia iliaca compartment block (FICB) following femoral fracture surgery provides effective analgesia. Reports of morphine added to ropivacaine for peripheral nerve blocks are limited. We designed this study to investigate the effects of morphine as an adjuvant to ropivacaine in FICB for femoral fracture surgery. Methods: Seventy patients undergoing spinal anaesthesia for femoral fracture surgery were randomized to undergo ultrasound aided FICB with ropivacaine alone (n = 35) or in combination with morphine (n = 35). FICB was performed postoperatively with 20 ml of 0.375% ropivacaine plus 2 ml normal saline or 20 ml of 0.375% ropivacaine plus 2 ml (1 mg/ ml) morphine. Primary outcome parameter was the duration of analgesia. Secondary outcome parameters were total doses of rescue analgesics, sedation scores, Numeric Rating Scale (NRS) scores for pain and patient satisfaction. Results: Demographic data were similar between the two groups. Patients receiving morphine adjuvant had longer duration of postoperative analgesia (541 ± 167 vs 634 ± 164 mins, p = 0.01; Mean difference -92.71; 95% CI: -171.95 – -13.47). Requirement of postoperative rescue analgesics for the first 24h was significantly lesser (tramadol 77 ± 25 vs 62 ± 22 mg, p = 0.01; Mean difference 14.28 ;95% CI: 2.95 – 25.63) in patients receiving morphine adjuvant. Postoperative NRS scores and sedation scores were comparable between the two groups. Conclusion: Morphine as an adjuvant to ropivacaine for FICB significantly prolongs the duration of postoperative analgesia.

Is Saddle block superior to spinal anaesthesia for patients undergoing transurethral resection of prostate- a comparative evaluation

Background: TURP is the most common surgical intervention for patients with benign prostatic hyperplasia. Aims and Objectives: This prospective randomized study was planned to evaluate spinal anaesthesia (SA) versus saddle block with regard to haemodynamic parameters, ephedrine consumption, patient and surgeon satisfaction, perioperative complications in patients undergoing TURP. Materials and Methods: Eighty patients between the ages of 50-80 years with BPH, belonging to ASA grade I- III, prostatic volume between 50 - 80 cc were included in our study. Patients were randomly divided into two groups of 40 patients each. Patients in group SA (n=40) received spinal anaesthesia and the patients in group SBBI (n=40) were given saddle block with bladder instillation of local anaesthetic jelly for undergoing TURP. Results: There was more statistically significant fall in MAP in Group SA as compared to Group SBBI (p&lt;0.05). Complications like hypotension, bradycardia and vasopressor requirement was less but requirement (p=0.021) of supplemental analgesia was more in patients who were administered saddle block. There was significantly lower patient satisfaction in saddle block (p=0.044) but comparable surgical satisfaction in both groups. Conclusion: Both Spinal anaesthesia and saddle block are safe and effective techniques of anaesthesia for patients undergoing TURP. SA has advantages like less requirement of supplemental analgesia, longer duration of post-operative analgesia and more patient satisfaction. However, saddle block is superior to spinal anaesthesia with regard to haemodynamic stability; with less chances of hypotension, bradycardia and less vasopressor requirement. It is similar to SA in terms of providing adequate surgical conditions.

A Comparative Study between Caudal and Penile Blockade in Pediatric Patients Undergoing Hypospadias Repair

Abstract Background Regional anesthesia, in combination with general anesthesia, is frequently used for children undergoing surgical procedures. Aim of the Work to compare postoperative analgesia between caudal block and penile block with bupivacaine in elective hypospadias repair cases in pediatric patients. Patients and Methods This study is a randomized clinical study conducted in the operating theaters of pediatric surgery unit in Ain shams university hospitals. The study was performed after ethical committee approval and informed consent from the parents after full explanation of the procedure, possible side effects and complications. This study was done in the period between March 2019 and August 2019.it included sixty male children undergoing hypospadias repair. Results Postoperative pain was evaluated by FLACC pain score at PACU, 2, 4 and 8, 12, 16 and 24 hrs. There was a significant increase in the pain score in group C starting from the fourth hour postoperativly and thereafter every hour, while the lowest pain scores were recorded in group P (P &amp;lt; 0.05). Also, the time to first need for rescue analgesia was significantly shorter in group C (240 +/-105 min) compared with group P (720 +/-301) (P&amp;gt;0.01).The total rescue analgesic requirement was significantly lower in group P (168.26 +/22.69) than group C (573.8+/- 124.1) (P &amp;lt; 0.01).Postoperative time of ambulation was significantly lower in group C (6.95+/- 3.22) compared with group P (5.28+/-1.99) (P &amp;lt; 0.01). Conclusion Dorsal penile nerve block in children undergoing penile surgery provides effective and a longer duration of postoperative analgesia and decreased postoperative analgesic requirements with more hemodynamic stability both intraoperatively and postoperatively, as it is safer and easier to perform, with higher success rates than caudal epidural block, which is invasive and shows some difficulty in practice.

Efficacy of intrathecal fentanyl versus buprenorphine as an adjuvant to isobaric levobupivacaine in lower limb surgeries

Background: Fentanyl and buprenorphine are the most commonly used adjuvants in spinal anesthesia. There is paucity in literature regarding the comparison of these two adjuvants when used with levobupivacaine. Aim: This study aimed to compare the efficacy and safety of fentanyl and buprenorphine added to isobaric levobupivacaine. Materials and Methods: This prospective randomized double-blind study was undertaken on 60 patients between the ages of 18 and 65 years with the American Society of Anesthesiologists (ASA) physical status 1, 2, and 3 scheduled for lower limb surgery. Group LF (n = 30) received 3-mL isobaric 0.5% levobupivacaine with 10 microgram (mcg) injection fentanyl and Group LB (n = 30) received 3-mL isobaric 0.5% levobupivacaine with 60 mcg injection buprenorphine. Characteristics of sensory and motor blockade, duration of postoperative analgesia, hemodynamic parameters, and adverse effects were recorded. Data were analyzed by appropriate statistical tests and a value of P &lt; 0.05 was considered significant. Results: The onset of sensory block and duration of motor block in both groups were comparable (P &gt; 0.05). The onset of motor block, duration of sensory block, and duration of analgesia were significantly prolonged in Group LB than Group LF (P &lt; 0.05). Six patients in Group LF and three patients in Group LB developed nausea, although the difference was not statistically significant (P = 0.2801). None of the patients in either of the study groups had adverse effects such as bradycardia, hypotension, pruritus, or respiratory depression. Conclusion: Combinations of 0.5% isobaric levobupivacaine (3 mL) with fentanyl (10 mcg) and buprenorphine (60 mcg) show a good safety profile when administered intrathecally, although combination of levobupivacaine–buprenorphine is superior in terms of prolonged sensory block and longer duration of postoperative analgesia.

A Randomised Controlled Trial to Assess the Analgesic Efficacy of Reduced Dose 0.2% Ropivacaine-Dexmedetomidine Combination Compared to Standard 0.375% Ropivacaine in USG Guided TAP Block for Paediatric Hernia Repair.

Paediatric pain management has remained understated practice over a period of time. Recently ultrasound-guided (USG) guided techniques are gaining popularity for perioperative analgesia, especially in the paediatric population. So, the aim of the present study was to evaluate the efficacy of reduced dose ropivacaine-dexmedetomidine combination compared to standard 0.375% ropivacaine in USG guided transversus abdominis plane (TAP) block. Sixty children of either sex, aged 2-10 years, posted for elective open herniotomy under general anaesthesia were randomly divided into two groups of 30 patients each. Group RD received 0.2% ropivacaine with dexmedetomidine 1 mg kg 1 while group R received 0.375% ropivacaine at 0.5mL kg 1. Meantime to first rescue and total analgesics, Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) and Ramsay sedation score, haemodynamic parameters and adverse effects were noted. Time to first rescue analgesia in group RD and group R were 16.32 6 3.11 hours and 10.82 6 2.16 hours, respectively (P < .0001). Mean CHEOPS score were 4.48 6 1.1 and 6.3 6 1.74 (P < .024) in group RD and R. Post-op Ramsay sedation score was significantly greater in group RD. Heart rate and blood pressure remained similar in either of the group. No episode of respiratory depression, bradycardia or hypotension was noted perioperatively. Combination of 1 mg kg 1 dexmedetomidine with reduced concentration of ropivacaine (0.2%) produced significantly longer duration of post-operative analgesia and lowered post-operative CHEOPS pain score in comparison with 0.375% ropivacaine alone in USG guided TAP block for paediatric hernia repair.

Comparison of hypotensive properties of dexmedetomidine versus clonidine for induced hypotension during functional endoscopic sinus surgery: A randomised, double-blind interventional study.

Background and Aims:Excessive bleeding is a major concern in functional endoscopic sinus surgery (FESS) under general anaesthesia; this can be decreased by various hypotensive agents. This study was conducted to compare the hypotensive effectiveness and haemodynamic stability of dexmedetomidine and clonidine in patients undergoing elective FESS.Methods:In this prospective double-blinded interventional study, 70 adult patients of either sex, 20–50 years of age, posted for elective FESS were randomly assigned to two groups. Group A received a loading dose of intravenous (IV) dexmedetomidine 1 μg/kg, followed by infusion of 1 μg/kg/h, and group B received a loading dose of IV clonidine 2 μg/kg, followed by 1 μg/kg/h infusion. Surgical field quality, emergence time, sedation score, visual analogue score, recovery profile and haemodynamic parameters were recorded. Statistical analysis was done by Student's unpaired t-test to evaluate the significance of normally distributed variables, whereas Mann–Whitney test and Chi-square test were used for ordinal data and categorical variables and proportions, respectively.Results:In both the groups, target mean arterial pressure (MAP) of 65–70 mmHg and improved surgical field quality were achieved. MAP and heart rate (HR) were statistically significantly lower in the dexmedetomidine group with a longer duration of post-operative analgesia (P = 0.001). None of the groups showed any statistically significant adverse effects.Conclusions:Both dexmedetomidine and clonidine can be used for controlled hypotension to improve surgical field quality in FESS. Dexmedetomidine provides more haemodynamic stability and an additional benefit of post-operative analgesia and conscious sedation.

Comparative study of intrathecal fentanyl with bupivacaine and fentanyl midazolam with bupivacaine in spinal anaesthesia

Spinal anaesthesia is preferred for lower abdominal and lower limb surgeries. Bupivacaine is the most popular local anaesthetic for subarachnoid blockade because of less neurotoxicity. Intrathecal bupivacaine alone may be insufficient to provide prolonged post-operative analgesia, even with high sensory block. So, various adjuvants are used like ketamine, midazolam, clonidine, opioids, neostigmine etc. to prolong the effect of local anaesthetic.To compare the effect of intrathecal fentanyl and fentanyl-midazolam combination with hyperbaric bupivacaine for quality of anaesthesia and post-operative analgesia.Study was conducted on 60 patients aged 20-60 years and were randomly divided into two groups of 30 patients each. Group A received 0.5% bupivacaine heavy 3 ml (15mg) + fentanyl 0.5 ml (25µg) and Group B 0.5% bupivacaine heavy 2.8 ml (14mg) +fentanyl 0.5 ml (25 µg) + midazolam 0.2 ml (1mg). Total volume is 3.5 ml in both groups. They were assessed for quality of block, post-operative analgesia and perioperative complications.Data were compared using t- test(unpaired). The level of significance used was p&amp;#60;0.05.There was a significant difference in onset and duration of sensory and motor block, time to administer first rescue analgesia in group B.Addition of midazolam (1mg) to fentanyl with bupivacaine intrathecally gives better onset &amp; duration of sensory &amp; motor blockade and longer duration of post-operative analgesia.

A COMPARATIVE STUDY OF ROPIVACAINE VERSUS ROPIVACAINE WITH DEXMEDETOMIDINE AS AN ADJUVANT IN SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK

BACKGROUND : Supraclavicular approach to brachial plexus block is a versatile and reliable regional anesthesia technique and a suitable alternative to general anesthesia for upper limb surgical procedures. Ropivacaine , a long acting local anesthetic, with less tendency for neurotoxicity and cardiotoxicity is a great local anesthetic for the procedure. Use of adjuvant Dexmedetomidine , a potent alpha 2 adrenoreceptor agonist improves the quality of anesthesia as well as intra-operative and post-operative analgesia while maintaining haemodynamic stability, arousable sedation and mild respiratory depression. MATERIALS AND METHODS: Eighty patients aged between 18 and 60 years with ASA grade I or II posted for elective upper limb surgeries were included in the study and were randomly divided into 2 groups with forty patients in each. Group A received 0.5% ropivacaine (31 mL) and Group B received 0.5% ropivacaine + dexmedetomidine 1microgram/kg (31mL). Both groups were compared for onset time and duration of sensory blockade, onset time and duration of motor blockade , total duration of analgesia and associated side effects. CONCLUSION : Dexmedetomidine as an adjuvant to ropivacaine in the supraclavicular brachial plexus block for upper limb surgeries , significantly shortens the onset time and prolongs the duration of sensory and motor blocks, with longer duration of post-operative analgesia , with associated significant sedation and a few manageable side effects like bradycardia and hypotension.

Comparison of motor blockade, sensory blockade and duration of analgesia between dexmedotomidine and dexamethasone as an adjuvant to bupivacaine in axillary block

Introduction: Axillary block with Bupivacaine mixed with adjuvants like dexmedetomidine, a more selectivealpha2 adrenoreceptor agonist, induces faster onset of blockade, delays the absorption of local anaesthetic and prolongs its action. Steroid adjuvants like dexamethasone can decrease inflammation at the same time demonstrated prolonged analgesic effect. The study aimed at comparing the efficacy of these adjuvants in affecting regional block onset and duration. Materials and Methods: This Randomized, uncontrolled, single blinded, two-arm, concurrent parallel trial was conducted during January to March 2017 among 60 participants posted for forearm and hand surgeries randomly allocated into two groups viz: Group A: 30 subjects given a mixture (30ml) of Bupivacaine (0.25%) and Dexamethasone (8mg) and Group B: 30 subjects given 30ml a mixture (30ml) of Bupivacaine (0.25%) and 1 ml of dexmedotomidine (100µg). The intra and post-operative outcomes of the two groups were compared statistically. Results: The onset of motor and sensory blockade was significantly (p Conclusion: Dexmedotomidine when compared with Dexamethasone used as an adjuvant to Bupivacaine in axillary block for forearm and hand surgeries showed marked efficacy in terms of earlier onset of action, prolonged blockade and longer duration of post-operative analgesia. Keywords: Bupivacaine, Axillary block, Dexmedotomidine, Dexamethasone.

A Randomized Controlled Double-Blind Comparative Study between Bupivacaine 0.25% Plus Fentanyl and Bupivacaine 0.25% Plus Dexmedetomidine for Caudal Epidural Postoperative Analgesia in Pediatric Lower Abdominal and Urogenital Surgeries in Indian Genotype

Abstract Objectives This study aimed to clinically evaluate and compare the efficacy of caudal epidural bupivacaine in prolonging the postoperative analgesia, with adjuvants like fentanyl or dexmedetomidine among children of Indian genotype. Materials and Methods A prospective double-blind randomized comparative study. The study population of 68 patients of Indian phenotype were randomly taken from a random number table and divided into two groups with 34 patients in each group. They received single shot caudal epidural blocks, with group A receiving 0.75 mL/kg of 0.25% bupivacaine + 1 mcg/kg fentanyl, group B receiving 0.75 mL/kg of 0.25% bupivacaine + 1 mcg/kg dexmedetomidine. Global Assessment of anesthesia, defined as the time from caudal injection to the first administration of rescue analgesia, will be recorded for both the groups. Results The addition of either fentanyl or dexmedetomidine as adjuvants in caudal block provided excellent postoperative analgesia, and sedation was significantly longer duration with dexmedetomidine (18.0 hours) than fentanyl (13.1 hours). We observed good hemodynamic stability in both the groups. Conclusion Addition of dexmedetomidine over fentanyl to bupivacaine for caudal epidural analgesia in pediatric age group has multiple advantages like better control of intraoperative and postoperative hemodynamics, significantly longer duration of postoperative analgesia, lesser bleeding during surgery, and achieving good surgical satisfaction. As the children are pain-free, calm, quiet, and sedated but arousable, the parents’ satisfaction is rewarding. The caudal epidural dose of 0.25% bupivacaine 0.75 mL/kg with adjuvants like dexmedetomidine or fentanyl is effective for postoperative analgesia in lower abdominal surgeries and is without side effects among the Indian population.