Low-dose Bupivacaine Research Articles

A Comparative Study Evaluating the Effectiveness of Epidural Volume Expansion with Normal Saline in Combined Spinal Epidural Anesthesia for Infraumbilical Surgeries using Low-Dose Intrathecal Hyperbaric Bupivacaine

A Comparative Study Evaluating the Effectiveness of Epidural Volume Expansion with Normal Saline in Combined Spinal Epidural Anesthesia for Infraumbilical Surgeries using Low-Dose Intrathecal Hyperbaric Bupivacaine

A Comparative Study between Epidural Morphine Bolus and Ropivacaine-fentanyl Infusion in Gastrointestinal Oncosurgeries: A Randomised Clinical Trial (MORFIN Study)

Background and Aims: Epidural local anaesthetic infusion is the gold standard analgesia technique after abdominal surgery. However, hypotension associated with it often leads to the administration of large amounts of fluid, increased vasopressor requirement, reduction of epidural drug dose and thus increased intravenous opioid consumption. Epidural morphine can be an alternative technique. Methods: Eighty-six patients scheduled for open elective gastrointestinal (GI) oncosurgery were enroled in the study. In Group ROP, analgesia was provided with a 6 ml bolus of epidural ropivacaine (0.2%)-fentanyl (2 µg/ml) followed by an infusion at 3–10 ml/h during the perioperative period. In Group MOR, a bolus of epidural morphine 0.05 mg/kg in 10 ml bupivacaine 0.1% was administered every 8–24 h. In both groups, rescue analgesia was provided with intravenous fentanyl. The primary outcome of the study was to compare post-operative fentanyl consumption between the two groups. Results: Mean ± standard deviation (95% confidence interval) fentanyl consumption was significantly lower in Group MOR in the first 24 h (92 ± 191 [33, 151] vs. 255 ± 263 [173, 338] µg in Group ROP; P < 0.01), 24–48 h (71 ± 203 [9, 134] in Group MOR vs. 261 ± 357 [150, 372] in Group ROP; P < 0.001) and 48–72 h (51 ± 168 [0, 103] in Group MOR vs. 240 ± 319 [140, 339] in Group ROP; P < 0.001) in the post-operative period. Pain scores at rest and during movement were significantly lower in group MOR in the immediate post-operative period. The post-operative fluid requirement in the first 24 h was also significantly lower. Conclusion: Intermittent boluses of epidural morphine with low-dose bupivacaine are associated with lesser post-operative fentanyl consumption compared to epidural ropivacaine-fentanyl infusion after GI oncosurgery.

Intrathecal Dexmedetomidine as an Adjuvant to Low Dose Hyperbaric 0.5% Bupivacaine on Haemodynamic Parameters in Patients Undergoing Transurethral Resection of Prostate.

To determine the role of dexmedetomidine in potentiating the local anaesthetic efficacy of a low dose of bupivacaine when used as an adjuvant. A prospective, double-blind, randomised study. Place and Duration of the Study: Department of Anaesthesia, Sindh Institute of Urology and Transplantation, Karachi, Pakistan, from July 2021 to February 2022. One hundred and eight patients of ASA physical class I-III undergoing transurethral resection of the prostate (TURP) under sub-arachnoid block (SAB) were enroled and distributed into two equal groups. Group BUPIPURE (BP) was given 7.5 mg of pure 0.5% hyperbaric bupivacain whereas group BUPIDEX (BD) was given 6 mg of 0.5% hyperbaric bupivacain with 3 μg dexmedetomidine intrathecally. The effects in Both groups were compared using chi-square and unpaired t-tests. A significance level of p <0.05 was used to evaluate the statistical significance. Both groups demonstrated a steady decrease in mean heart rate (mean HR 98.9-62.7 per minute as compared to 79.1-59.4 per minute in groups BP and BD, respectively), however, no patient reached to HR <50/min. Group BP had a higher HR variability than group BD. The two groups' median peak sensory levels were similar. However, a statistically significant difference was revealed in the time taken for 2-segment regression (87.5 ± 11.3 min vs. 115.5 ± 6.2 min p <0.001 in BP and BD), as well as the time to reach T10 sensory level (13.56 ± 2.5 min vs. 10.9 ± 3.0 min p <0.001). In patients having TURP, intrathecal dexmedetomidine combined with low-dose bupivacaine results in a quicker start, extended sensory and motor block, and a decreased need for rescue analgesics. Adjuvants, Dexmedetomidine, Spinal anaesthesia, Transurethral Resection of Prostate.

Feasibility and safety of ultrasound-guided supra-clavicular block in children

BackgroundUltrasound-guided supra-clavicular nerve block (SCNB) has regained interest in adults but remains underutilized in pediatrics. This case series aims to evaluate the efficacy and safety of ultrasound-guided SCNB in children undergoing upper-extremity surgery. MethodsProspective observational case series, the inclusion criteria were children over one year old who were scheduled for elective upper-extremity surgery. After induction of general anesthesia, an ultrasound-guided SCNB was performed. A dose of 0.2–0.5 ml/kg of bupivacaine 0.25 % or ropivacaine 0.2 % was administered all around the brachial plexus. In case of postoperative pain, 15 mg kg-1 of paracetamol + 10 mg kg-1 of ibuprofen were administered. The primary outcome measure was the success and safety of the block. Secondary outcomes were time to first analgesia administration and duration of motor blockade. ResultsThirty-three patients were included. Median age and weight were 6 [2.75,9.75] years and 24 [16,35] kg, respectively with a sex ratio of 3.1. Bupivacaine 0.25 % was used in the majority of cases (N = 24). The overall duration to complete block performance was 170 [120,300] seconds. A single attempt was sufficient for the majority of children, with a block success rate of 100 %. No incidents were reported during block performance. Postoperatively, time to the first analgesic request was 10 [8,12.5] hours. Twenty-five patients developed a motor block, with a duration of 4 [0.5,5] hours. Bupivacaine 0.25 % was associated with higher incidence of motor blockade (p = 0.002). ConclusionsUltrasound-guided SCNB appears to be an effective and safe technique in children. Further studies using lower doses of bupivacaine could help reduce the incidence of motor block.

A Comparative Analysis between Conventional-Dose and Low-Dose Bupivacaine &amp; Fentanyl among Patients with Open Cholecystectomy under Spinal Anesthesia in a Tertiary Care Hospital: A Prospective Observational Study

A Comparative Analysis between Conventional-Dose and Low-Dose Bupivacaine &amp; Fentanyl among Patients with Open Cholecystectomy under Spinal Anesthesia in a Tertiary Care Hospital: A Prospective Observational Study

Outcome of Subarachnoid Block with Low Dose Bupivacaine and Fentanyl for Lower Limb Vascular Surgeries in Patients with Coronary Artery Disease

Subarachnoid block (SAB) with local anesthetics and opioids (fentanyl) and able to perform spinal anesthesia because of the synergistic effects and allow top use of low dose local anesthetics which results in a stable hemodynamic state. A randomized clinical trial was conducted to observe the cardiovascular effects of subarachnoid block (SAB) with low dose bupivacaine and fentanyl on patient with coronary artery disease, between January 2021 and December 2022. A total of 36 patients who had known case of coronary artery disease. All patients underwent spinal block for lower limb surgery with 7.5 mg hyperbaric bupivacaine 0.5% and 25 µg fentanyl. In each patient, 1 mg I/V midazolam was used and if needed subsequent may be given. Complications related to anesthesia such as hypotension, bradycardia, vasopressor need, and blood or volume use were recorded. Our study shows at the 90-minutes of spinal block, patients with EF ≤40% experienced a decrease of 10.5% in systolic blood pressure, while those with EF&gt;40% experienced a larger decrease of 19%. At the 90-minutes of spinal block, percentage decrease was higher in the EF&gt;40% group (19.5% vs. 14%) in diastolic blood pressure. At the 90-minutes of spinal block, patients with EF ≤ 40% experienced a decrease of 13% in MAP, while those with EF&gt;40% experienced a larger decrease of 19%. The findings demonstrate that patients with EF&gt;40% exhibited larger percentage decreases in systolic blood pressure, diastolic blood pressure, and MAP compared to those with EF ≤40%. The difference was statically significant (P&lt;0.05). Our study recommends subarachnoid block with low dose of bupivacaine and fentanyl is effective in lower limbs surgeries for patients with coronary artery disease particularly with low EF. CBMJ 2024 July: vol. 13 no. 02 P: 169-175

A comparative study of low-dose intrathecal bupivacaine 0.5% (heavy), levobupivacaine 0.5% (plain), and levobupivacaine 0.5% (heavy) with fentanyl as an adjuvant in transurethral resection of prostate surgery: A prospective randomized study

Background: Spinal anesthesia is the technique of choice for transurethral resection of the prostate (TURP) surgeries. Levobupivacaine, an S-enantiomer of bupivacaine, is less cardiotoxic than bupivacaine; therefore, a low dose of local anesthetic with fentanyl as an adjuvant has been used to decrease toxicity and increase efficacy. Aims and Objectives: The aim of this study was to compare and evaluate the efficacy of hyperbaric bupivacaine 0.5%, isobaric levobupivacaine 0.5%, and hyperbaric levobupivacaine 0.5% with fentanyl as an adjuvant. Materials and Methods: One hundred and five patients scheduled for elective TURP surgeries were randomly divided into three groups. Group BH (n=35) received 1.5 mL of 0.5% hyperbaric bupivacaine with 25 μg of fentanyl, Group LH (n=35) received 1.5 mL of 0.5% hyperbaric levobupivacaine with 25 μg of fentanyl, and Group LP (n=35) received 1.5 mL of 0.5% isobaric levobupivacaine with 25 μg of fentanyl intrathecally. Results: The onset of sensory and motor block was earlier and the duration of analgesia and motor block were longer in the BH group (P&lt;0.001) as compared to LH and LP groups. The demographic data, duration of surgery, heart rate, SpO2, pruritus, and shivering were comparable between the groups (P&gt;0.05). The visual analog scale score was higher in the LP group. Hypotension, nausea, and vomiting were seen in the BH group. Conclusion: Hyperbaric is better than isobaric group due to quicker onset and longer duration. Levobupivacaine is better than bupivacaine in terms of the early mobilization and a lesser incidence of side effects, making hyperbaric levobupivacaine a better alternative to isobaric levobupivacaine and hyperbaric bupivacaine.

Pain Management Following Intracavitary Brachytherapy Procedures: A Prospective, Randomized, Double-Blind Study.

Background and objectives Intracavitary applicators are a source of significant discomfort after brachytherapy procedures while undergoing subsequent radiation treatment. With strides towards opioid-sparing anesthesia and analgesia, it's essential to find appropriate substitutes. This procedure requires adequate relaxation of pelvic muscles during the procedure and proper analgesia after the procedure, with the presence of intracavitary applicators, needed for radiation treatment. We studied the day-case safety and analgesic efficacy of adjuvants dexmedetomidine 3 µg and fentanyl 15 µg intrathecally to low-dose 0.5% hyperbaric bupivacaine. Methods Seventy females scheduled for brachytherapy procedures were randomly allocated to receive either Group I (0.5% hyperbaric bupivacaine (1.8 ml) plus 3µg dexmedetomidine (0.3ml)) or Group II (0.5% hyperbaric bupivacaine (1.8 ml) plus 15µg fentanyl (0.3ml)). The primary outcome was to assess and compare the brachytherapy (day-case) feasibility with 3µg dexmedetomidine and 15µg fentanyl (time taken to meet hospital discharge criteria). The secondary outcomes were the absolute duration of spinal analgesia, pain scores, patient satisfaction scores, and any associated adverse events. Data analysis was done using IBM SPSS software for Windows, version 21.0 (IBM Corp., Armonk, NY). Results All patients in Group I were discharged on the same day without any adverse effects. They underwent an intracavitary brachytherapy procedure under spinal anesthesia with stable hemodynamics successfully. The mean time taken to meet hospital discharge criteria in Group II was shorter than in Group I (258.43 ± 27.460 vs. 335.71 ± 21.114). The mean absolute duration of spinal analgesia was significantly longer in Group I as compared to Group II (406.82 ± 51.78 mins vs. 267 ± 16.23 mins) (p<.001). Seventeen patients required rescue analgesia in Group II versus eight in Group I (p<0.025). Conclusion Patients in both groups received excellent analgesia with enhanced patient satisfaction. Three µg intrathecal dexmedetomidine as an adjuvant to low-dose hyperbaric bupivacaine can be used safely in day-case brachytherapy procedures. It provides adequate anesthesia and prolonged spinal analgesia as compared to 15 µg fentanyl.

Dexmedetomidine Or Fentanyl as An Adjuvant to Single Low-Dose Bupivacaine Intrathecal Anesthesia for Management of Normal Labor Pain, A Randomized Control Study

Dexmedetomidine Or Fentanyl as An Adjuvant to Single Low-Dose Bupivacaine Intrathecal Anesthesia for Management of Normal Labor Pain, A Randomized Control Study

Comparison of subarachnoid administration of low-dose bupivacaine and lidocaine in healthy goats.

This study aimed to compare the effects of low-dose subarachnoid injections of 2% lidocaine (LIDO) and 0.5% bupivacaine (BUPI) in goats. 6 healthy, privately owned female goats. In this randomized blind crossover clinical trial, each goat received 0.05 mL/kg-1 of LIDO, BUPI, or sterile saline solution into the lumbosacral subarachnoid space, with a seven-day washout. Cardiorespiratory variables, rectal temperature, and somatosensory (pinprick) and motor (ataxia) functions were recorded at baseline (time 0) and 2, 5, 10, 15, and 30 minutes after injection, then every 20 minutes until the goat was standing and able to walk. Time to regain somatosensory and motor functions was compared between treatments using Kaplan-Meier survival curves and the Cox proportional hazards model. Linear mixed-effects models were used to compare cardiorespiratory variables between treatments and over time. A P value ≤ .05 was considered significant. Somatosensory recovery was longer with BUPI, though not statistically significant. The median time to stand was 50 (50, 67) minutes after LIDO injection and 104 (101, 156) minutes after BUPI injection (P = .031). The median time to walk was 72 (54, 85) minutes after LIDO versus 225 (220, 245) minutes after BUPI injection (P = .031). Cardiovascular and respiratory variables showed no significant differences between treatments. Despite prolonged ataxia with BUPI, pinprick sensation recovery did not differ. At reduced doses, both LIDO and BUPI are deemed acceptable for short procedures of the flank, pelvic limb, or tail in healthy goats.

Administration of Low-dose Hyperbaric Bupivacaine for Spinal Anesthesia in the Setting of Outpatient Arthroplasty.

With the rise of ambulatory surgery centers (ASCs), rapid motor and sensory recovery after anesthesia is crucial. The purpose of this study was to evaluate the safety and efficacy of low-dose single-shot hyperbaric bupivacaine for spinal anesthesia (SA) for patients undergoing outpatient arthroplasty. Data were reviewed from a single ASC from 2018 to 2020 for two arthroplasty-trained surgeons for all patients with primary arthroplasties that had administration of low-dose hyperbaric bupivacaine. Data collected from the ASC records were then further evaluated for total spinal block time, length of blockade, time to discharge criteria, visual analog scale (VAS) scores, and time to discharge. Two hundred twenty-seven patients undergoing 244 primary arthroplasties received SA with low-dose hyperbaric bupivacaine. The volume of 0.75% bupivacaine varied: 115 patients received 0.8 mL (6 mg), 111 patients received 1.0 mL (7.5 mg), and 17 patients received 1.2 mL (9 mg). Total SA time averaged 144 minutes with a mean of 30 minutes from post anesthesia care unit arrival to motor recovery. The mean time from post anesthesia care unit arrival to discharge criteria was 89 minutes. The average VAS at discharge was 1.44; the average VAS on POD1 was 3.0. No episodes of urinary retention and no reports of transient neurologic symptoms were noted in the study population. Low-dose, single-shot hyperbaric bupivacaine SA is an effective option in the ASC for arthroplasty, providing a fast return of motor function, facilitating rapid discharge, and is safe with a relatively low-risk profile.

Comparison Of Variations Of Low Dosage Spinal Anesthesia On Mobilization Speed After Caesarea Sectio Eracs Method At Hermina General Hospital Purwokerto

Enhanced Recovery After Caesarian Surgery (ERACS) is the development of sectio caesarean delivery techniques that offer preoperative, intraoperative, and postoperative care to hasten patient recovery. The ERACS technique is related to using low-dose spinal anesthesia, which is using a bupivacaine dose of 3.75–12 mg. The use of low doses in sectio caesarean can help the speed of patient mobilization, which can be measured by achieving a Bromage score. The study aims to compare the effectiveness of giving low-dose spinal anesthesia type bupivacaine 6 mg compared to bupivacaine 7.5 mg on the post-sectio caesarea mobilization speed of the ERACS (Enhanced Recovery After Caesarian Surgery) method at Hermina General Hospital Purwokerto. This type of research is observational and analytical with a cross-sectional study approach. The sampling technique used was consecutive sampling, so a study sample of 58 respondents was obtained, which was divided into two groups, namely the bupivacaine dose group of 6 mg and the bupivacaine dose group of 7.5 mg. Results were analyzed using the Mann-Whitney test. The results of statistical tests showed that the bupivacaine group at a dose of 6 mg and the bupivacaine group at a dose of 7.5 mg (p = 0.534) did not have a significant difference in effectiveness against the onset of post-sectio caesarean mobilization speed of the ERACS method (P &gt; 0.05). This study concludes that there is no difference between the comparison of the effectiveness of administering low-dose spinal anesthesia type bupivacaine 6 mg compared to bupivacaine 7.5 mg on the speed of mobilization after caesarean section using the ERACS (Enhanced Recovery After Caesarian Surgery) method at Hermina General Hospital Purwokerto. The maximum time achieved for the onset of mobilization after ERACS to achieve a bromage score is in the range of 1 – 2 hours (60 – 120 minutes) with the level of mobilization after caesarean section being a score of 1 and a score of 0.

Comparative analysis of low-dose bupivacaine and ropivacaine combined with spinal-epidural anesthesia in cesarean sections for pregnant women with coexisting mental illness

Objective To analyze the application effects of low-dose bupivacaine and ropivacaine combined with epidural anesthesia. Methods The primary outcome measure was the anesthesia effect, assessed by the excellent anesthesia rate. Secondary outcomes included the occurrence of adverse reactions, blood pressure, and serum prolactin levels at different time points. The anesthesia effect, serum prolactin levels, occurrence of adverse reactions, and MAP at various time points [before anesthesia (T0), 5 min after anesthesia (T1), at the start of surgery (T2), at delivery of the fetus (T3), and at closure of the abdomen (T4)] were compared between the two groups. Results ① Anesthesia effect: The excellent anesthesia rate was 71.88% in the control group and 93.94% in the observation group, with a significantly higher rate in the observation group than in the control group (p = 0.017). ② Serum prolactin levels: The serum prolactin levels in both groups increased significantly after surgery compared to before surgery (p < 0.001); however, there was no statistically significant difference in serum prolactin levels between the two groups before and after surgery (p = 0.651). ③ Occurrence of adverse reactions: The occurrence rate of adverse reactions was 28.13% in the control group and 9.09% in the observation group, with a significantly lower rate in the observation group than in the control group (p = 0.048). Conclusion In cesarean sections for pregnant women with coexisting mental illness, low-dose ropivacaine demonstrates significantly better anesthesia efficacy, blood pressure stability, and anesthesia safety compared to low-dose bupivacaine. Both low-dose bupivacaine and ropivacaine result in increased prolactin levels postpartum.

Caesarean section under spinal anesthesia for a mother with dilated cardiomyopathy in a resource-limited setting: a case report

Introduction and importance: Peripartum cardiomyopathy is an uncommon form of cardiomyopathy that develops in the latter stages of pregnancy or in the first few weeks following delivery. Anaesthetic management of caesarean section of a parturient with dilated cardiomyopathy is challenging due to its nature of impaired ventricular contractility coupled with cardiovascular changes during pregnancy. This is significantly worse in a resource-constrained environment with restricted access to medications and equipment. Case presentation: We report a case of a 31-year-old multigravida parturient presented with a diagnosis of dilated cardiomyopathy and a low ejection fraction undergoing emergency caesarean section. Successful management of a parturient with dilated cardiomyopathy undergoing a caesarean section under spinal anaesthesia is reported in this case report. Clinical discussion: Spinal anaesthesia is another alternative for the successful management of patients with dilated cardiomyopathy (DCM) using a low dose of bupivacaine with intrathecal adjuvants. Our report indicates that caesarean section also may be managed safely with spinal anaesthesia alone in patients with DCM, by using low-dose bupivacaine and intrathecal morphine. The slight haemodynamic changes were adjusted with fluid infusion. The use of vasopressors was not required to manage the hypotension. Conclusion: General anaesthesia, epidural alone, and epidural combined with spinal anaesthesia are the widely used anaesthetics techniques for caesarean section in patients with heart disease. Spinal anaesthesia with low-dose bupivacaine with opioids is another suitable choice. The case report is written according to the CARE guideline (https://www.care-statement.org).

Spinal Anesthesia in a Patient with reduced Ejection Fraction undergoing Below-Knee Amputation

The ejection fraction is calculated by dividing the stroke volume by the end diastolic volume. It is literally the fraction of the end diastolic ventricular volume that is ejected with each beat. This measurement is important to know how well the heart is pumping out blood and decide in diagnosing heart failure (HF). Normally the percentage of EF is above 50%. A decrease in EF will make it difficult to perform anesthesia during surgery due to life-threatening arrhythmia, leading to sudden cardiac arrest and death. Patients with reduced ejection fraction need identification of risk factors, preoperative evaluation and optimization, correct medical therapy, adequate monitoring, and appropriate anesthetic technique and drugs. In this report, we present a 46-year-old man with reduced ejection fraction 30% and coronary artery disease who underwent below knee amputation surgery under spinal anesthesia. Spinal anesthesia was performed on the patient using low dose bupivacaine and fentanyl as adjuvant. Management of patients is aimed at maintaining adequate preload, avoiding tachycardia and arrhythmia along with maintaining afterload by maintaining a balance between oxygen supply and demand. Thus in patients with reduced ejection fraction, who are posted for noncardiac surgeries, the more preferable and safer alternative is regional anesthesia as it reduces the sympathetic stress response

Unilateral Spinal Anesthesia in Hip Fracture Surgery for Geriatric Patients With High Cardiovascular Risk due to Aortic Stenosis is Safe and Effective.

Aortic stenosis is a cause of mortality or morbidity. It complicates the selection and management of anesthetic procedures. The aim of this study was to evaluate the efficacy, hemodynamic effects and postoperative outcome of unilateral spinal anesthesia in geriatric patients with hip fractures with moderate or severe aortic stenosis. A retrospective observational study was conducted on geriatric high-risk patients with cardiac conditions who underwent surgery for hip fractures under unilateral spinal anesthesia with low-dose hyperbaric bupivacaine. The study period spanned from January 2018 to December 2021. The inclusion criteria were individuals with moderate to severe aortic stenosis, as defined by the American Heart Association Criteria. Data on demographic information, cardiac pathologies, hemodynamic data, data on motor and sensory block, perioperative complications, and mortality rates at 30th and 180th days were collected. Mortality rates at the 30th day and 180th day were 8.9% (n:4) and 24.4% (n:11), respectively. T6 level was predominantly obtained level of anesthesia (44.4%). Motor and sensory block formation times averaged 7.6 and 4.8 minutes, respectively. Surgical procedures were performed mostly within 1 hour (66.7%), and complications were rare (11.1% hypotension). Initial analgesic effect showed a rapid resolution, with 64.4% of patients requiring analgesic within the first hour postoperatively. In elderly patients with moderate to severe aortic stenosis scheduled for hip fracture surgery, we posit that unilateral spinal anesthesia with ultra-low dose is safe and effective option.

Comparison of intrathecal low-dose bupivacaine and morphine with intravenous patient control analgesia for postoperative analgesia for video-assisted thoracoscopic surgery

BackgroundThoracoscopic surgical techniques continue to advance, yet the intensity of postoperative pain remains significant, impeding swift patient recovery. This study aimed to evaluate the differences in postoperative pain and recuperation between patients receiving intrathecal morphine paired with low-dose bupivacaine and those administered general anesthesia exclusively.MethodsThis randomized controlled trial enrolled 100 patients, who were allocated into three groups: Group M (5 μg/kg morphine intrathecal injection), Group B (5 μg/kg morphine combined with bupivacaine 3 mg intrathecal injection) and Group C (intrathecal sham injection). The primary outcome was the assessment of pain relief using the Numeric Rating Scale (NRS). Additionally, intraoperative remifentanil consumption was quantified at the end of the surgery, and postoperative opioid use was determined by the number of patient-controlled analgesia (PCIA) compressions at 48 h post-surgery. Both the efficacy of the treatments and any complications were meticulously recorded.ResultsPostoperative NRS scores for both rest and exercise at 6, 12, 24, and 48 h were significantly lower in groups M and B than in group C (P<0.05). The intraoperative remifentanil dosage was significantly greater in groups M and C than in group B (P<0.05), while there was no significant difference between groups M and C (P>0.05). There was no significant difference in intraoperative propofol dosage across all three groups (P>0.05). Postoperative dosages of both sufentanil and Nonsteroidal anti‐inflammatory drugs (NSAIDs) were significantly less in groups M and B compared to group C (P<0.05). The time of first analgesic request was later in both groups M and B than in group C (P<0.05). Specific and total scores were elevated at 2 days postoperative when compared to scores at 1 day for all groups (P<0.05). Furthermore, at 1 day and 2 days postoperatively, both specific scores and total scores were higher in groups M and B compared to group C (P<0.05).ConclusionIntrathecal administration of morphine combined with bupivacaine has been shown to effectively ameliorate acute pain in patients undergoing thoracoscopic surgery.Trial registrationThe trial was registered on ClinicalTrials.gov: ChiCTR2200058544, registered 10/04/2022.

Anesthetic Management for Urgent Caesarean Section in Patient with Uncontrolled Hyperthyroidism and Severe Mitral Regurgitation

&lt;p&gt;&lt;strong&gt;Background :&lt;/strong&gt;The prevalence of hyperthyroidism in pregnancy approximately 0.05% to 3% and mostly caused by Graves’ Disease (GD). The prevalence of Hyperthyroid Heart Disease (HHD) in pregnancy is 3.87%. Uncontrolled hyperthyroidism during pregnancy can increase maternal and fetal mortality. We report a case of a pregnant woman with uncontrolled hyperthyroidism and severe mitral regurgitation that underwent cesarean section with spinal anesthesia for delivery.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Case Illustration :&lt;/strong&gt;A 33 years-old patient G4P1A2 visited the Obstetric-Gynecology outpatient clinic at our hospital at 23 weeks of gestation (WoG) due to uncontrolled hyperthyroidism caused by GD that diagnosed 3 years ago and shortness of breath. The echocardiography test obtained severe mitral regurgitation and left atrial dilatation with 58% LVEF. It was decided to maintain the pregnancy till the fetus is viable while still monitoring the patient’s condition. At 32 WoG, the patient came to the ED due to shortness of breath, chest pain, and nausea. Fetal movement and fetal heart rate (FHR) were within normal limits. The patient was given a nasal cannula at 3 liters/minute, extra furosemide 20 mg, and fetal lung maturation with dexamethasone injection. The patient was prepared for termination by cesarean section. Spinal anesthesia was performed in a sitting position using a 27 G spinal needle. Inserted at L 3-4, using a low dose of heavy bupivacaine 0.5% 7.5 mg combined with 25 g fentanyl and 0.1 mg morphine intrathecally. C-section was successfully performed and hemodynamics during surgery was stable, resulting the delivery of a preterm baby who weighed 1.9 kg at birth and the baby was transferred to the NICU for further treatment.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion : &lt;/strong&gt;Spinal anesthesia with low dose bupivacaine combined with opioids for cesarean section was revealed maternal and neonate safe.&lt;/p&gt;

Transitioning from intrathecal bupivacaine to mepivacaine for same-day discharge total joint arthroplasty: a quality improvement study

IntroductionSame-day discharge total knee and hip arthroplasty is becoming more common. Anesthetic approaches that optimize readiness for discharge are important. Based on an institutional change from low-dose bupivacaine to mepivacaine,...

Comparison of low dose ropivacaine plus dexmedetomidine vs. low dose bupivacaine for spinal anesthesia in transurethral resection of prostate

Background &amp; Objective: Spinal anesthesia (SA) has been preferred for transurethral resection of prostate (TURP) due to various advantages over general anesthesia. The most commonly used drug for SA is bupivacaine, but recently ropivacaine has been introduced with better hemodynamic profile. Dexmedetomidine is sedative-analgesic, and can be used through multiple routes. We compared low dose ropivacaine plus dexmedetomidine vs. low dose bupivacaine for SA in TURP.&#x0D; Methodology: This comparative, cross-sectional study was conducted at Anesthesia Department of Combined Military Hospital, Lahore, from December 2021 to June 2022.&#x0D; A total of 197 patients, planned to undergo TURP under SA were included in the study. The patients were randomly allotted to one of the two groups by lottery method and using concealed envelops. Group RD took low dose ropivacaine (7.5 to 10 mg) plus dexmedetomidine (5 µg) and in Group B low dose bupivacaine (7.5 to 10 mg) was used for spinal anesthesia. Parameters of efficacy and safety were compared in both groups during and immediately after the surgery to look for better option among the two regimes.&#x0D; Results: Out of 197 patients randomized into two groups, Group RD, 99 (50.2%) took low dose ropivacaine (7.5 to 10 mg) plus dexmedetomidine (5 µg) and 98 (49.8%) took low dose bupivacaine (7.5 to 10 mg) for spinal anesthesia. Mean age of patients who underwent TURP in our study was 61.66 ± 7.88 y. Hemodynamic instability and requirement of opiate analgesia was not significantly different in both the groups (P &gt; 0.05) while all other efficacy parameters were better in patients who took low dose ropivacaine plus dexmedetomidine (P &lt; 0.05) as compared to those who only took low dose bupivacaine.&#x0D; Conclusion: Both groups showed no difference in safety parameters related to hemodynamic stability but the anesthesia profile was better in patients who took low dose ropivacaine plus dexmedetomidine as compared to the bupivacaine group.&#x0D; Abbreviations: SA - Spinal anesthesia; TURP - Transurethral resection of prostate&#x0D; Key words: Bupivacaine; Dexmedetomidine; Ropivacaine; Anesthesia, Spinal; Transurethral Resection of Prostate&#x0D; Citation: Ul Hassan J, Zafar E, Akram M, Saleem MA, Sami A. Comparison of low dose ropivacaine plus dexmedetomidine vs. bupivacaine for spinal anesthesia in transurethral resection of prostate. Anaesth. pain intensive care 2023;27(5):535−538; DOI: 10.35975/apic.v27i5.2309