Low Dose Hyperbaric Bupivacaine Research Articles

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.

Continuous Spinal Anaesthesia for Below Knee Amputation in High Risk Case: A Case Report

Introduction: Lower limb ischemia, peripheral arterial disease, and diabetes mellitus are considered the major cause for limb amputations in more than 50% of cases. These patients have increased risk of perioperative mortality and morbidity due to additional comorbidities, such as cardiac diseases. Continuous spinal anaesthesia (CSA) provides better cardiovascular stability, less local anaesthetic requirement, better control of anaesthesia level and lower risk of local anaesthetic toxicity were reported in the CSA technique compared with a single-dose spinal anaesthesia technique. We reported a high-risk patient who underwent below knee amputation surgery under CSA. Case Report: This is a 50-year-old male, American Society of Anaesthesiologists (ASA) III, dilated cardiomyopathy admitted for below knee amputation surgery. Preop vitals are stable. Blood investigations are normal. Chest radiography showed cardiomegaly, and echocardiography revealed sinus tachycardia with poor R wave progression and low ejection fraction (EF) of 20%. Continuous spinal anaesthesia was planned for the procedure, during the surgery total amount of fluid given was 40 mL of crystalloids at the rate of 20ml/hr. Intraop vitals stable. The patient was transferred to post op ward following the removal of spinal catheter. No anaesthetic complications noted. Conclusion: We reported the successful anaesthetic management of a patient with coronary artery disease and low ejection fraction undergoing below knee amputation surgery. CSA technique with low dose hyperbaric bupivacaine provided safe and effective ananaesthesia with minimal haemodynamic changes for this case.

Hemodynamic and analgesic effect of intrathecal dexmedetomidine with low dose hyperbaric bupivacaine in spinal anaesthesia, caesarean section: a randomized controlled trial

Hemodynamic and analgesic effect of intrathecal dexmedetomidine with low dose hyperbaric bupivacaine in spinal anaesthesia, caesarean section: a randomized controlled trial

COMPARISON OF BUPIVACAINE-DEXMEDETOMIDINE VS BUPIVACAINE-FENTANYL VS BUPIVACAINE -SALINE FOR UNILATERAL SPINAL ANAESTHESIA IN LOWER LIMB SURGERY

Introduction: Addition of adjuvants like Dexmedetomidine and Fentanyl to hyperbaric Bupivacaine has been proposed to improve the quality of spinal anaesthesia. Aims and Objectives: The aim of current study was to compare the effects of adding Dexmedetomidine, Fentanyl and saline to low dose hyperbaric Bupivacaine (1 ml, 0.5%) on the properties of unilateral spinal anaesthesia. Methods and Materials: 120 patients divided into three groups. The spinal anaesthetic agent in each of the three groups was 1 mL bupivacaine 0.5% (5 mg). In groups BD, BF and BS, 5mcg of Dexmedetomidine, 25mg of Fentanyl and 0.5 mL saline were added, respectively. The duration of the motor and sensory blocks in both limbs and the assessment of pain during 24 h after surgery were noted. Results: Duration of motor and sensory block were significantly longer in the BF and BD groups than the BS group. Mean total number of rescue analgesic required were less in group BD and BF compared to group BS. Conclusions: Addition of Dexmedetomidine and Fentanyl to low dose Bupivacaine in unilateral spinal anaesthesia increase the duration of the motor, sensory block and post op analgesia.

Рестриктивная (5 мл/кг) и либеральная (10 мл/кг) преднагрузка при односторонней спинальной анестезии малой дозой (5 мг) гипербарического бупивакаина при артроскопических операциях на коленном суставе

Актуальность. При проведении артроскопических операций на коленном суставе применяется односторонняя спинальная анестезия малой дозой бупивакаина. Особое значение при одностороннем блоке придается профилактике гипотензии и быстрой выписке из больницы. Одним из методов такой профилактики является преднагрузка инфузионными растворами. Рестриктивная преднагрузка позволяет снизить объем вводимых растворов по сравнению с либеральной преднагрузкой. Продолжается поиск объема преднагрузки, достаточного для предотвращения гипотензии и обеспечения быстрой выписки, при односторонней спинальной анестезии малой дозой гипербарического бупивакаина при проведении артроскопических операций на коленном суставе. Цель исследования — выбор оптимального метода преднагрузки (либеральной — 10 мл/кг или рестриктивной — 5 мл/кг 0,9% раствора NaCl) для профилактики гипотензии и поддержания гемодинамической стабильности при проведении односторонней спинальной анестезии малой дозой (5 мг) гипербарического бупивакаина при артроскопических операциях на коленном суставе с возможностью быстрой выписки пациентов из больницы. Материалы и методы. 30 пациентов, которым было запланировано проведение артроскопических операций на коленном суставе, были распределены на 2 группы по 15 человек. В группе 1 применялась либеральная преднагрузка (10 мл/кг) при односторонней спинальной анестезии малой дозой гипербарического бупивакаина. В группе 2 использовалась рестриктивная преднагрузка (5 мл/кг) при односторонней спинальной анестезии малой дозой гипербарического бупивакаина. Проводилась оценка гемодинамических показателей и критериев выписки. Результаты. Не было выявлено случаев развития гипотензии в обеих группах на всех этапах исследования. На фоне спинальной анестезии за 15 мин до начала операции и при повороте пациента на спину отмечалось достоверное снижение систолического артериального давления в группе 2 (105,2 ± 4,3* мм рт.ст. и 116,4 ± 4,6 мм рт.ст. в группах 2 и 1 соответственно, *p < 0,05) и диастолического артериального давления в группе 2 (66,7 ± 3,7* мм рт.ст. и 78,1 ± 3,2 мм рт.ст. в группах 2 и 1 соответственно, *p < 0,05). При начале операции сохранялось достоверное снижение систолического артериального давления в группе 2 (103,7 ± 5,1* мм рт.ст. и 121,5 ± 6,5 мм рт.ст. в группах 2 и 1 соответственно, *p < 0,05). Более быстрое восстановление самостоятельного мочеиспускания (128,7 ± 12,3* мин и 157,2 ± 16,6 мин в группах 2 и 1 соответственно, *p < 0,05) позволило обеспечить возможность более быстрой выписки пациентов (152,7 ± 14,2* мин и 178,5 ± 15,5 мин в группах 2 и 1 соответственно, *p < 0,05). Выводы. Применение либеральной (10 мл/кг) преднагрузки предотвращает развитие гипотензии, позволяет сохранить стабильные показатели гемодинамики в периоперационном периоде, обеспечивает быстрое восстановление самостоятельного мочеиспускания и выписку из стационара при односторонней спинальной анестезии малой дозой гипербарического бупивакаина при артроскопических операциях на коленном суставе. Применение рестриктивной (5 мл/кг) преднагрузки предотвращает развитие гипотензии, приводит к лабильным показателям гемодинамики на начальном этапе анестезии, обеспечивает ускоренное восстановление самостоятельного мочеиспускания и выписку из стационара при односторонней спинальной анестезии малой дозой гипербарического бупивакаина при артроскопических операциях на коленном суставе.

An Observational Study between Intrathecal Fentanyl and Butorphanol with Low Dose Bupivacaine to Facilitate Early Ambulation in Perineal Surgeries

Background: Neuraxial opioids are widely used with local anaesthetics as they allow lower dose of local anaesthetics while providing adequate anaesthesia and faster recovery from spinal anaesthesia because of their sympathetic and motor nerve sparing activities. In the last few years the number of surgeries performed on an ambulatory basis has increased worldwide because of many advantages like short hospital stay, less chance of wound infection and less chances of deep vein thrombosis.Methods: 64 patients of ASA- I or II of either gender who underwent perineal surgeries were divided into two groups of 32 each:- Group BF patients received 1ml of 0.5% hyperbaric bupivacaine with 20µg fentanyl(0.4ml) and Group BB patients received 1ml of 0.5% hyperbaric bupivacaine with 200µg butorphanol(0.2ml) and normal saline(0.2ml).Patients were observed for onset of sensory and motor blockade, duration of sensory and motor blockade, duration of analgesia and time to unassisted ambulation. There was no difference in onset of sensory and motor blockade between the two groups(P> 0.005).Patients receiving butorphanol had statistically significantly longer duration of sensory and motor blockade and duration of analgesia than fentanyl(p-0.001).Patients receiving fentanyl were observed to ambulate unassisted significantly early compared to butorphanol (p-0.001).Conclusion: Patients receiving intrathecal fentanyl 20µg can ambulate earlier compared to patients receiving butorphanol 200µg when used as an adjuvant with low dose hyperbaric bupivacaine 0.5% without any complication.

Evaluation of low dose hyperbaric bupivacaine with or without fentanyl in perianal surgeries: A prospective randomized double blind trial

Spinal anaesthesia should be ideal for perianal surgeries due to its quick onset, reliable anaesthesia with minimal supplies making it cost-effective technique with rapid turnover time.90 patients of ASA grade I-II scheduled for perianal surgeries divided into three groups of 30 each according to intrathecal dose of local anaesthetic: Group LB (Low dose bupivacaine): 0.6 ml of 0.5% hyperbaric bupivacaine (3mg), Group ULBF (ultralow dose bupivacaine plus fentanyl): 0.4 ml of 0.5% hyperbaric bupivacaine (2 mg) + 0.2 ml of fentanyl (10 µg) and Group ULB (ultra low dose of bupivacaine): 0.4 ml of 0.5% hyperbaric bupivacaine (2 mg) + 0.2 ml of normal saline. Three groups were compared in terms of success of block, time to first rescue analgesic from time of block, total rescue analgesic (tramadol) needed in 8 hours since time of block, visual analogue score (VAS) and patient satisfaction score.Successful saddle block was achieved in all patients in Group ULBF, 27 patients in Group LB and none in Group ULB. Group ULBF showed significantly lower mean VAS score when compared to Group ULB and Group LB, and Group LB when compared to Group ULB. Thus the group using fentanyl intrathecally had significantly lesser pain, so the requirement for the first dose of rescue analgesic was significantly earlier in Group ULB and delayed in Group ULBF. Patient satisfaction score was significantly higher in Group ULBF as compared to Group LB and Group ULB and in Group LB as compared to Group ULB.Use of hyperbaric bupivacaine in dose of 3 mg and 2 mg with fentanyl (10 μg) in saddle block are an effective method of achieving successful surgical anaesthesia in patients undergoing perianal surgeries. Hyperbaric bupivacaine (2mg) with fentanyl (10µg) is better than other in providing postoperative analgesia.

English

English

Low dose hyperbaric bupivacaine 5 mg combined with 50 mcg fentanyl for cesarean section in maternal heart disease

Background & Aims: Most of the women with cardiovascular diseases suffer from worsening of their clinical condition during pregnancy. It is caused by cardiovascular physiological changes during pregnancy and increased demand of oxygen-metabolic system. Spinal anesthesia is the most commonly used technique in cesarean section (CS) patients, but there are concerns about sudden hemodynamic decrease. We aimed to investigate the use of low dose hyperbaric bupivacaine 5 mg combined with 50 μg fentanyl for caesarean section in patient with heart disease.Methodology: This study is a retrospective study in 33 patients with maternal heart disease undergoing CS under low dose spinal anesthesia in Saiful Anwar Hospital Malang Indonesia from September 2017 until September 2018. The spinal regimen was administered with 5 mg bupivacaine heavy 0.5% combined with 50 μg fentanyl. We evaluated the hemodynamic preoperative, post injection of spinal anesthetics, postdelivery, and at the end of surgery. We also evaluated Bromage score, Apgar score of the baby, and satisfaction level by the obstetrician.Results: Combination of low dose spinal and opioid for the CS delivery show no significant hypotension effects. Hemodynamic stabilization was achieved. Furthermore, target blocked was reached well in all cases, no significant changes in Apgar score of the baby, and obstetrician satisfied with motor relaxation.Conclusion: Low dose spinal anesthesia using 5 mg of bupivacaine heavy 0.5% and adjuvant opioid fentanyl 50 μg can be successfully used for the performance of CS delivery satisfactory block, good fetal outcome, and impressive cardiovascular stability.Citation: Husodo DP, Isngadi I, Hartono R, Prasedya ES. Low dose hyperbaric bupivacaine 5 mg combined with 50 mcg fentanyl for cesarean section in maternal heart disease. Anaesth pain & intensive care 2019;23(3):274-278

USE OF DEXMEDETOMIDINE AS AN ADJUVANT TO 0.5% HYPERBARIC BUPIVACAINE IN SUBARACHNOID BLOCK

[1] Kanazi GE, Aouad Mt, KJabbour-Khoury SI et al: Effect of low dose dexmedetomidine or clonidine on the characteristics of spinal bupivacaine block. Act a Anaesthesiol Scand 2006;50:222-7 [2] Hala EEA, Mohamed SA, Hend Y. Dose related prolongation of hyperbaric bupivacaine spinal anaesthesia by dexmedetomidine. Ain Shams J Anaesthesiology 2011;4:83-95 [3] Kim JE, Kim NY, Lee HS, Kil HK. Effects of intrathecal dexmedetomidine on low dose bupivacaine spinal anaesthesia in elderly patients undergoing transurethral prostectomy. Bio Pharm Bul 2013;36;959-965. [4] Mahendru V, Tewari A, Katyal S et al. A Comparison of intrathecal dexmedetomidine, clonidine, & fentanyl as adjuvants to hyperbaric bupivacaine for lower limb surgery: A double blind controlled study. J Anaesthesiol Clin Phrmacol 2013;29:496-502 [5] Soumya samal et al: Intrathecal buterphenol or intrathecal dexmedetomidine for post operative analgesia a comparative study: healt agenda, vol 2. Issue 1. Jan 2014 [6] Dexmedetomidine in anaesthesia practice: a wonder drug? IJAaug 2014 by S K Harsoor [7] Sudheesh K, Raghvendra Rao R S, Kavya M, Aarthi J, Rani D D, Nethra S S. Comprative study of 2 doses of intrathecal dexmedetomidine as adjunct with low dose hyperbaric bupivacaine in ambulatory perianal surgeries. A prospective randomized controlled study. Indian J Anaesth 2015;59:648-52 [8] El-Attar A, Aleen MA, Beltagy R, Ahmed W. A comparative study of intrathecal dexmedetomidine and fentanyl as additives to bupivacaine. Res Opin Anesth Intensive care 2015;1:43-9 [9] Kurhekar P, Kumar SM, Sampath D. Comparative evaluation of intrathecal morphine and intrathecal dexmedetomidine in patients undergoing gynecological surgeries under spinal anaesthesia. A prospective randomized double blind study. Indian J anaestg 2016;60:382-7

Low Dose Hyperbaric Bupivacaine with Fentanyl in Spinal Anesthesia in Elective Cesarean Section

Background: Spinal anesthesia with hyperbaric bupivacaine provides a dense neural block in cesarean delivery but associated with side effects like hypotension, bradycardia nausea and vomiting. Addition of low dose fentanyl with low dose of hyperbaric bupivacaine may decrease the in­cidence of these complications. The aims of study was to compare the hemodynamic parameters (blood pressure and heart rate), nausea and vomiting with low dose intrathecal hyperbaric bupivacaine with fentanyl vs a conventional dose of intrathecal hyperbaric bupivacaine in patient undergoing elective cesarean section.
 Methods: Seventy-four pregnant women aged 20-35 years old which un­derwent elective cesarean section at Chitwan Medical College were ran­domized into two groups. One group received spinal anesthesia with 8mg of0.5% hyperbaric bupivacaine and 25μg fentanyl and another group re­ceived 12mg 0.5% bupivacaine.
 Results: The mean age, baseline heart rate, systolic and diastolic blood pressure were comparable in both groups. Significant difference in hypo­tension (24.31% vs. 62.16%, p<0.05) and Nausea and vomiting (16.20% vs. 27%, p<0.05) were found in bupivacaine-fentanyl group versus a conven­tional dose of spinal bupivacaine group.
 Conclusions: Low dose of bupivacaine with Fentanyl provides good spinal anesthesia for cesarean section with less hypotension, nausea and vomit­ing in comparison to bupivacaine alone.

Incidence of hypotension between Intrathecal Hyperbaric Bupivacaine with and without Fentanyl in Geriatric Patients Undergoing Urological Surgeries

Objective: We aimed to assess the efficacy, the incidence of hypotension and adverse consequences of using intrathecal hyperbaric bupivacaine in comparison to a combination of low dose hyperbaric bupivacaine and fentanyl, in geriatric patients undergoing urological surgeries.Material and Methods: Our study was a prospective, triple-blinded and randomized controlled. One hundred and fortyeight geriatric participants scheduled for urological surgeries were randomly assigned into two groups: Group B (n=74) received intrathecal injection with 0.5% hyperbaric bupivacaine 1.5 milliliters (ml) alone (7.5 milligrams; mg), while Group F (n=74) received 0.5% hyperbaric bupivacaine 1 ml (5 mg) plus 0.5 ml of fentanyl (25 micrograms; mcg) making up to a total volume of 1.5 ml.Results: One hundred and forty-eight patients were included however, six patients were excluded from statistical analysis, due to an inadequate level of anesthesia; hence, 142 patients were analyzed. The incidence of hypotension in group B was: 9.7%, and in group F the percentage was 12.9%, respectively (p-value=0.74). There was no significant difference in regards to the highest sensory level in both groups. The anesthesia level in group B was Thoracic level 11 (T10-T12), and in group F it was 11 (T10-T12) (p-value=0.68), while the analgesia level in group B was Thoracic level 7 (T6-T8) with group F being a Thoracic level 6 (T6-T8) (p-value=0.16). The occurrence of bradycardia, and respiratory depression did not differ between the 2 groups.Conclusion: Intrathecal administration of 5 mg of 0.5% hyperbaric bupivacaine, plus 25 mcg of fentanyl provided an adequate level of sensory blockade, but did not decrease the frequency of hypotension.

Anesthetic effects of varying doses of Fentanyl combined with spinal Bupivacaine in caesarean delivery

Introduction: Spinal opioids have gained popularity in recent years as they augment the analgesia produced by local anesthetics. Fentanyl is one of the opioids used for such purpose however the optimal dose has not been described adequately in the literature available so far in our setup. The aim of this study is to find out the effect of adding various doses of Fentanyl to low dose hyperbaric Bupivacaine intrathecally.Materials and methods:Seventy-five parturients scheduled for caesarean delivery were randomly allocated into three groups (Bupivacaine-Fentanyl) BF10, BF20 and BF30 who received intrathecal 0.5% hyperbaric Bupivacaine 1.6 ml with Fentanyl 10µg, 20 µg and 30 µg respectively. Total volume was made to 2.2ml by adding normal saline. The outcomes measured were peak sensory level, degree of motor block, quality of intraoperative anesthesia, duration of effective analgesia, neonatal APGAR score and side effects were noted if any.Results: Peak sensory level and degree of motor block was similar in all the groups. Peak sensory level (Thoracic Dermatome) was 4.52± 0.82, 4.32± 0.62 and 4.32± 0.74 (p=0.540) in BF10, BF20 and BF30 respectively. Degree of motor block was not significantly different (p=1.000). Quality of intraoperative anesthesia improved from BF10 to BF20 (P=0.040) but did not improve significantly from BF20 and BF30 (P=0.189). Duration of effective analgesia prolonged as the dose of Fentanyl increased which was in minutes 173.64±41, 216.80±32 and 273.16±35 (p=0.000) in BF10,BF20 and BF30 respectively. Neonatal APGAR scores were similar in all groups and very little adverse effects in higher doses.Conclusion: The combination of 1.6 ml of 0.5% hyperbaric Bupivacaine and 20 µg of Fentanyl intrathecally provides excellent surgical anesthesia, prolonged postoperative effective analgesia with very few side effects. Increasing the dose of Fentanyl beyond it could prolong the postoperative pain relief but at the cost of increased adverse effects.

Anesthetic effects of varying doses of Fentanyl combined with spinal Bupivacaine in caesarean delivery

<p><strong>Introduction</strong></p><p>Spinal opioids have gained popularity in recent years as they augment the analgesia produced by local anesthetics. Fentanyl is one of the opioids used for such purpose however the optimal dose has not been described adequately in the literature available so far in our setup. The aim of this study is to find out the effect of adding various doses of Fentanyl to low dose hyperbaric Bupivacaine intrathecally.</p><p><strong>Materials and methods</strong></p><p>Seventy-five parturients scheduled for caesarean delivery were randomly allocated into three groups (Bupivacaine-Fentanyl) BF10, BF20 and BF30 who received intrathecal 0.5% hyperbaric Bupivacaine 1.6 ml with Fentanyl 10µg, 20 µg and 30 µg respectively. Total volume was made to 2.2ml by adding normal saline. The outcomes measured were peak sensory level, degree of motor block, quality of intraoperative anesthesia, duration of effective analgesia, neonatal APGAR score and side effects were noted if any.</p><p><strong>Results</strong></p><p>Peak sensory level and degree of motor block was similar in all the groups. Peak sensory level (Thoracic Dermatome) was 4.52± 0.82, 4.32± 0.62 and 4.32± 0.74 (p=0.540) in BF10, BF20 and BF30 respectively. Degree of motor block was not significantly different (p=1.000). Quality of intraoperative anesthesia improved from BF10 to BF20 (P=0.040) but did not improve significantly from BF20 and BF30 (P=0.189). Duration of effective analgesia prolonged as the dose of Fentanyl increased which was in minutes 173.64±41, 216.80±32 and 273.16±35 (p=0.000) in BF10,BF20 and BF30 respectively. Neonatal APGAR scores were similar in all groups and very little adverse effects in higher doses.</p><p> <strong>Conclusion</strong></p><p>The combination of 1.6 ml of 0.5% hyperbaric Bupivacaine and 20 µg of Fentanyl intrathecally provides excellent surgical anesthesia, prolonged postoperative effective analgesia with very few side effects. Increasing the dose of Fentanyl beyond it could prolong the postoperative pain relief but at the cost of increased adverse effects.</p>

Sufentanil in combination with low-dose hyperbaric bupivacaine in spinal anesthesia for cesarean section: a randomized clinical trial

A double blind randomized clinical trial of sufentanil as an adjunct in spinal anesthesia for cesarean section and, thereby, be able to reduce the dose of bupivacaine, a local anesthetic, with the same result of an anesthetic block with higher doses but with fewer perioperative side effects, such as hypotension.

Comparison between high dose hyperbaric Bupivacaine (12.5 mg) alone versus low dose hyperbaric Bupivacaine (7.5 mg) with Fentanyl (25 µg) in spinal anaesthesia for inguinal hernia surgery

<p class="abstract"><strong>Background:</strong> For performing inguinal hernia surgeries, giving spinal anesthesia is a well known technique as it easy and provides fast onset, effective sensory and motor blockade in an awake patient. Now-a-days Bupivacaine is gaining importance as an effective spinal anaesthetic agent in combination with opioid analgesic Fentanyl to reduce the postoperative pain and side effects associated with surgery. This study aims to compare the effectiveness of intrathecal Bupivacaine alone versus combination of Bupivacaine with Fentanyl.</p><p class="abstract"><strong>Methods:</strong> The study designed was a prospective, randomized, double blinded comparative study. Patients were randomly divided into two groups of 25 each. Group B received hyperbaric intrathecal Bupivacaine 12.5 mg and Group BF received diluted hyperbaric intrathecal Bupivacaine 7.5 mg and Fentanyl 25 µg for spinal anesthesia . Parameters like sensory and motor block were assessed. Side effects produced during perioperative and postoperative period were observed and noted. Satisfactory criteria by the surgeons and patients were considered.</p><p class="abstract"><strong>Results:</strong> The time taken to attain surgical anesthesia and peak sensory levels in minutes was statistically significant in Group B compared to Group BF. Due to higher dose of Bupivacaine, it was observed that degree of motor blockade is also higher in group B when compared to group BF. The incidence of hypotension, nausea, vomiting and hypothermia are significantly higher in group B due to high dose of Bupivacaine. The surgeons and patients satisfaction was good in both the groups. </p><p><strong>Conclusions:</strong> Low dose Bupivacaine in combination with Fentanyl is safe and effective alternative for spinal anesthesia for inguinal herniorrphaphy as compared to conventional high dose Bupivacaine alone.</p>

Comparison of Different Doses of Clonidine as an Adjuvant to Intrathecal Bupivacaine for Spinal Anaesthesia in Patients Undergoing Lower Limb Orthopedic Surgery

Background: Clonidine is added to local anaesthetics as adjuvant in spinal anaesthesia to improve quality and duration of sensory and motor block. Dose of Clonidine used is varied from 15μg to 150 μg and most of the studies are with low dose (8mg to 12mg) hyperbaric bupivacaine. Aim: Aim of this study was to evaluate and compare the effects of addition of three different doses of clonidine (15, 30 and 45 μg) to 18 mg hyperbaric bupivacaine in patients undergoing lower limb orthopedic surgery under spinal anaesthesia Study design: Prospective, randomized, double-blind, controlled study. Materials and Methods: 120 patients enrolled in the study were randomly divided into four groups of 30 each. Group I ,II, III,and IV received 0,15,30 and 45μg of clonidine respectively as an adjuvant to 18 mg hyperbaric bupivacaine. The volume of the solution was kept constant to 4 ml by adding normal saline. Results: The mean time for two segment regression, mean duration of sensory and motor block were higher in all the Clonidine groups. Mean arterial pressure was lower and vasopressor requirement was higher with an increase in the dose of Clonidine. Conclusion: To conclude, the addition of 15 μg of clonidine as an adjuvant to hyperbaric bupivacaine for spinal anaesthesia was found to be effective compared to 30 μg of clonidine, 45μg of clonidine as it causes significant prolongation of motor and sensory block duration without causing any hemodynamic derangements.

Continuous Spinal Anesthesia for Hip Fracture Surgery in a very Old Patient With Pulmoner Hypertension

Elderly patients have increased risk for perioperative and postoperative mortality and morbidity due to additional comorbidities, such as cardiac diseases. Anesthesia and surgery in patients with pulmonary hypertension (PH) are associated with high perioperative morbidity and mortality, and elective surgeries should generally be avoided fort this reason. Anesthesia and surgery are associated with significantly increased morbidity and mortality in patients with PH due mainly to right ventricular failure, arrhythmias, postoperative hypoxemia, and myocardial ischemia. Regional anesthesia techniques are usually preferred in high-risk patients due to some advantages, such as the maintenance of cardiovascular stability and early postoperative mobilisation. This case presents the anaesthetic approach in a 87-year-old male patient with atrial fibrilation, chronic obstructive pulmonary disease and pulmonary hypertension who underwent hip fracture surgery. In the present case, continuous spinal anesthesia with low-dose hyperbaric bupivacaine provided safe and effective anaesthesia during surgery with minimal haemodynamic changes and analgesia during the first 24 hours after surgery.

Nepalankių kraujotakos reakcijų išsivystymo prognozavimas ir paciento kūno padėties įtaka širdies minutiniam tūriui mažųjų anorektalinių operacijų metu

Tikslas. Nustatyti pradinio širdies minutinio tūrio, matuojamo impedanso kardiografijos metodu, ribą, leidžiančią prognozuoti nepalankių kraujotakos reakcijų, sąlygotų paciento kūno padėties pokyčių, vystymąsi anorektalinių operacijų, atliekamų mažos dozės vietinių anestetikų spinalinėje nejautroje, metu pacientams, sergantiems lydimąja kardiovaskuline patologija.Darbo metodika. Perspektyvusis, stebimasis, klinikinis tyrimas, į kurį įtraukti 48 pacientai, įvertinti ASA 3 funkcinės būklės klase, turintys lydimąją kardiovaskulinę patologiją, stacionarizuoti mažajai anorektalinei operacijai, kuri atlikta mažos vietinių anestetikų dozės spinalinėje nejautroje. Iš jų 3 pacientai į vėlesnį tyrimą neįtraukti dėl įtraukimo kriterijų neatitikimo. Pacientai užklijuotų vokų metodo pagalba, atsitiktine tvarka buvo suskirstyti į dvi grupes: I grupė (n=24), tai pacientai, kuriems operacija atlikta paguldžius į lenktinio peilio padėtį, II grupė (n=24) – pacientai, kuriems operacija atlikta paguldžius į litotomijos padėtį. Operacijos metu buvo stebimi ir registruojami standartiniai rodikliai: širdies susitraukimų dažnis, elektrokardiograma, arterinis kraujo spaudimas bei impedanso kardiografijos parametrai: širdies minutinis tūris, sistolinis tūris, sisteminis kraujagyslių pasipriešinimas. Spinalinė anestezija buvo atlikta sušvirkščiant į subarachnoidinį tarpą 0,8ml (4mg) 0,5proc. hiperbarinio bupivakaino ir 0,2ml (10μg) fentanilo. Rezultatai. Širdies susitraukimų dažnis ir vidurinis arterinis kraujo spaudimas tarp grupių ir grupės viduje nesiskyrė (p>0,05). Širdies minutinis tūris statistiškai reikšmingai sumažėjo nuo pradinio 6,2±1,4 l/min. iki 3,1±0,9 l/min. pacientą paguldžius į lenktinio peilio padėtį ir išliko sumažėjęs operacijos pradžioje (3,0±0,8 l/min.) bei pabaigoje (3,1±0,7 l/ min.). Atitinkamai skirtumas tarp I ir II grupių paguldžius į operacijos padėtį buvo 3,7 l/min., operacijos pradžioje - 3,3 l/min. ir operacijos pabaigoje - 3,1 l/min. (p<0.05). Atlikus diskriminantinę analizę nustatėme, jog pradinė širdies minutinio tūrio riba, kuriai esant tikėtina, kad paguldžius pacientą į lenktinio peilio padėtį širdies minutinis tūris bus mažesnis nei 3,0 l/min., yra <5,94 l/min. Išvados. Lenktinio peilio padėtis anorektalinių operacijų metu veikia širdies minutinio tūrio sumažėjimą. Pacientams, įvertintiems ASA 3 klase dėl kardiovaskulinės patologijos, širdies minutinis tūris sumažės iki < 3,0 l/min., pacientą operacijos metu paguldžius į lenktinio peilio padėtį, esant pradiniam širdies minutiniam tūriui < 5,94 l/min.

Comparative study of two doses of intrathecal dexmedetomidine as adjuvant with low dose hyperbaric bupivacaine in ambulatory perianal surgeries: A prospective randomised controlled study.

Background and Aims:Dexmedetomidine (DMT), as intrathecal adjuvant has been shown to successfully prolong duration of analgesia but delay the motor recovery. Hence, this study was designed to find out the dose of DMT which can provide satisfactory analgesia without prolonging motor block.Methods:A total of 50 patients scheduled for elective perianal surgeries were randomly allocated to Groups C or D (n = 25). Group D received hyperbaric bupivacaine 0.5% 4 mg + DMT 5 μg and Group C received hyperbaric bupivacaine 0.5% 4 mg + DMT 3 μg intrathecally. Onset and duration of sensory and motor blockade, duration of analgesia, time for ambulation and first urination were recorded. Adverse effects if any were noted.Results:Demographic characters, duration of surgery were comparable. The onset of sensory block to S1 was 9.61 ± 5.53 min in Group C compared to 7.69 ± 4.80 min in Group D (P = 0.35). Duration of sensory (145.28 ± 83.17 min – C, 167.85 ± 93.75 min – D, P = 0.5) and motor block (170.53 ± 73.44 min – C, 196.14 ± 84.28 min, P = 0.39) were comparable. Duration of analgesia (337.86 ± 105.11 min – C, 340.78 ± 101.81 min – D, P = 0.9) and time for ambulation (252.46 ± 93.72 min – C, 253.64 ± 88.04 min – D, P = 0.97) were also comparable. One patient in each group had urinary retention requiring catheterization. No other side effects were observed.Conclusion:Intrathecal DMT 3 μg dose does not produce faster ambulation compared to intrathecal DMT 5 μg though it produces comparable duration of analgesia for perianal surgeries.