Maximum Level Of Sensory Block Research Articles

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

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

Effect of intra-abdominal pressure on maximum level of intrathecal sensory block: A preliminary randomized controlled trial

Objectives: Increase in Intra-Abdominal Pressure (IAP) is commonly accepted as a cause for intrathecal dose sparing and consequently higher level of sensory block during pregnancy. There is however very little actual data evaluating the relationship. Thus, we aimed to evaluate association between IAP and maximum level of sensory block following intrathecal injection of hyperbaric bupivacaine as well as plain levobupivacaine for cesarean section. Methods: Preliminary randomized controlled blinded trial included females aged 18-40 years, scheduled for elective cesarean section under single-shot subarachnoid block. After randomization, they received either intrathecal hyperbaric bupivacaine (group H) or plain (isobaric) levobupivacaine (group P) in a dose of 12.5 mg (n = 40 each). IAP was measured before and after the spinal block, using the recommended intravesical technique. The maximum level of sensory block and the IAPs were measured in each patient. Results: There was no significant correlation of IAPprespinal with maximum level of sensory block for group H (P = 0.334; rs = -0.157) or group P (P = 0.637; rs = -0.078). Similarly, there was no significant correlation of the IAPpostspinal: group H (P = 0.370; rs = -0.145); and group P (P = 0.714; rs = -0.061). Both group H and group P had similar IAPprespinal (15.9 [14.3-18.2] and 15.3 [14.3-17.4] mmHg, respectively) (P = 0.474); as well as IAPpostspinal (15.2 [13.8-17.2] and 14.6 [13.4-16.0] mmH, g respectively) (P = 0.239). Among ancillary observations, duration of sensory block was significantly longer for group P versus group H (133.6 ± 24.2 and 103 ± 23.4 mins; P < 0.000). However, the maximum levels of sensory and motor block, respective times required to achieve them, as well as incidences of intraoperative hypotension and bradycardia were statistically similar between group H and group P (P > 0.05). Conclusions: The IAP was raised to the level of conventionally defined intra-abdominal hypertension (>12 mmHg) in patients scheduled for elective cesarean section. However, despite being increased, the IAPprespinal or IAPpostspinal did not show any significant association with the maximum level of sensory block (P > 0.05).

Ntrathecal Hyperbaric Bupivacaine 0.5% with Varying Dose of Buprenorphine in Elective Adult Lower Limb Orthopaedic Surgeries: A Randomised Control Study

Introduction: Postoperative pain is a universal phenomenon and usually under treated and its intensity varies widely among patients. Spinal anaesthesia with opioid and local anaesthetics to prolong postoperative analgesia is common practice in recent years. Buprenorphine is an agonist - antagonist opioid. Intrathecal buprenorphine (30-150 µg) along with local anaesthetics is safe and known to increase the postoperative analgesia without affecting sensory or motor blockade and with lesser side effects. Aim: To compare the anaesthetic characteristics and its side effects in subarachnoid block with bupivacaine 0.5% heavy and varying dose of buprenorphine (90 µg and 120 µg). Materials and Methods: This randomised control study was conducted in the Jhalawar Medical College, Jhalawar, Rajasthan, India, from March 2019 to November 2019. The study included 90 patients belonging to American Society of Anaesthesiologists (ASA) class I and II of either sex age between 18 to 60 years posted for elective lower limb orthopaedic surgeries.The patients were divided into three groups; group A which included a patient count of 30 received plain hyperbaric bupivacaine 0.5% (2.5mL) with 0.5 mL saline. Group B which included 30 patients, receive plain hyperbaric bupivacaine 0.5% (2.5 mL) along with buprenorphine 90 µg diluted in 0.5 mL saline. Group C with a patient count of 30 received hyperbaric bupivacaine 0.5% (2.5 mL) with buprenorphine 120 µg mixed with 0.5 mL saline. Analgesic characteristics, haemodynamic parameters, side effects, sedation scores by Ramsay sedation score and pain scores by Visual Analogue Score (VAS) (0-10) were measured postoperatively till 24 hours.Statistical analyses of data were done by one Way Analysis of Variance (ANOVA) test and chisquare test where p-value less than 0.05 was considered to be a statistically significant value. Results: The onset time of sensory blockade (group A: 5.14±1.34, group B: 4.54±1.10, group C: 4.50±1.18 in minutes), time of onset of motor blockade (group A: 10.10±1.00, group B: 9.43±1.30, group C: 9.21±1.49 in minutes) and maximum level of sensory block at T6 level (group A: n-01/30, group B: n-04/30, group C: n-04/30) were comparable between the three groups and were not statistically significant. Sensory recovery time was significantly (p&lt;0.0001) delayed in group B and C (178.9±7.18 min and 189.23±7.4), while in group A it was 152.86±8.9 min. Duration of postoperative analgesia was significantly (p&lt;0.0001) prolonged in group C (group A 165.53±8.5, group B 391.49±19.8, group C 493.23±18 in minutes). Side-effects like Postoperative Nausea and Vomiting (PONV) and sedation were increased with dose of buprenorphine but easily treatable and not significant (p&gt;0.05). Conclusion: A higher dose of buprenorphine shows to provide an adequate and longer postoperative analgesia without any major side effects.

Sitting against Lateral Position for Spinal Anaesthesia in Elderly Patients Undergoing Lower Limb Surgeries: An Observational Study

Introduction: Age-related degenerative anatomical changes may make the spinal anaesthesia difficult. Sitting position is preferable due to easy identification of landmarks whereas lateral position is easy to maintain in case of elderly premedicated patients. Aim: To compare the effects of spinal anaesthesia position (sitting versus lateral) in the elderly patients on block characteristics (sensory and motor), haemodynamic parameters, patient’s comfort and satisfaction. Materials and Methods: The present prospective observational study was conducted in the Department of Anaesthesiology and Intensive care, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India, from November 2021 to May 2022. A total of 116 American Society of Anaesthesiologists (ASA) grade I-II patients of both sexes, age more than 70 years undergoing lower limb surgeries under spinal anaesthesia either sitting or lateral position were included in the study. These patients were divided in to two groups (sitting position-Group SP, lateral position-Group LP). Hyperbaric bupivacaine (0.5%) was injected into the subarachnoid space. After the spinal injection, assessments were made for block characteristics (sensory and motor), haemodynamic parameters and patient’s comfort and satisfaction. The discrete and categorical variables were analysed using Chi-square test. Results: The mean age of participants in Group SP and Group LP was 77.31±4.015 years and 76.69±4.901 years, respectively. Onset of sensory block after was significantly slower in Group SP (75.31±10.384 seconds) as compared to Group LP (64.23±7.758 seconds). Time required to achieve maximum level of sensory block was significantly higher in Group SP (8.11±1.416 minutes) than Group LP (6.67±1.324 minutes). There was no significant difference in Heart Rate (HR) in both groups, but there was significantly lower Systolic Blood Pressure (SBP) in Group SP than Group LP up to 12 minutes after spinal injection. However, the lateral position appears to be more comfortable for elderly patients as per the comfort score. Conclusion: Position for spinal anaesthesia, either sitting or lateral, has insignificant effects on block characteristics or on haemodynamic parameters except there was faster onset of sensory and motor block and more comfort in lateral position.

Intrathecal bupivacaine versus bupivacaine and clonidine in pediatrics: a double-blind controlled study

BackgroundSpinal anesthesia is establishing a place in pediatric daycare anesthesia as a possible substitute for general anesthesia in children undergoing infraumbilical abdominal or lower extremity surgeries. Clonidine intensifies the effect of bupivacaine when given intrathecally as an adjuvant.Methods and Objective of studyThis is a prospective randomized double-blind study carried out in 60 ASA physical status 1 and 2 (3–13 years) pediatric patients scheduled for infraumbilical abdominal or lower extremity surgeries. Participants were randomly allocated to two groups. Group B received hyperbaric bupivacaine 0.5% alone (0.4 mg/kg for wt. 5–15 kg or 0.3 mg/kg for wt. > 15 kg), and group BC received hyperbaric bupivacaine 0.5% (0.4 mg/kg for wt. 5–15 kg or 0.3 mg/kg for wt. > 15 kg) and preservative-free clonidine (1 μg/kg), comprising 30 patients each. The primary outcome was the measurement of the time of onset of sensory block, the maximum level of sensory block, duration of sensory block, and duration of post-op analgesia.ResultsThe mean onset of sensory block was 3.04 ± 1.5 min in group BC vs. 5.01 ± 0.30 in group B p = 0.0001. The mean onset of motor block was also earlier in group BC 3.81 ± 0.38 min vs. 6.47 ± 4.66 min in group B p = 0.0028. The mean duration of analgesia was 391.33 ± 33 min in group BC vs. 194.5 ± 28 min in group B with a p-value of 0.0001. None of the patients belonging to either group demonstrated a segmental level higher than T5.ConclusionsWe infer that clonidine is a good adjuvant to bupivacaine in spinal anesthesia in pediatric patients as far as comfort is concerned. It decreases the time taken for onset, has a longer duration of postoperative analgesia, and has a better quality of sedation with no added side effects as compared to bupivacaine alone, in pediatric patients undergoing surgeries below T8 dermatome.

A Comparison of the Injection Rate of Local Anesthetic during Spinal Anesthesia on the Onset of Sensory Block and Incidence of Hypotension in Caesarean Section

Objective: The injection rate of the local anesthetic may affect the level and the time of onset of sensory block. The aim of this prospective study was to investigate the effects of two different injection rates of local anesthetic solution (0.5% heavy bupivacaine) on the onset of sensory block, and the incidence and the onset of hypotension in pregnant women undergoing spinal anesthesia for elective Cesarean delivery. Methods: A total of 67 patients were randomized into two groups: 120-second injection time (Group Slow; n = 33) and 15-second injection time (Group Fast; n = 34). Maximum level of sensory and motor block, time to sensory block at the level of T6, hemodynamic parameters, use of ephedrine and incidence of side effects were recorded at measurement time points. Results: Maximum level of the sensory block was similar in both groups. The time to achieve adequate and maximum sensory block level was shorter in Group Slow(S) (p = 0.004 and 0.037, respectively). Incidence of hypotension was similar, but hypotension occurred earlier in Group Fast(F) (p = 0.011). Requirement for ephedrine and incidence of nausea and vomiting was similar. Conclusions: This study reveals that 120-second injection duration during spinal anesthesia is associated with shorter time to achieve the maximum sensory block level and slower onset of hypotension. It means that prolonging the duration of local anesthetic injection to 120-seconds is advantageous compared with 15-seconds in caesarean section.

The influence of epidural volume extension on spinal block with hyperbaric bupivacaine for elective knee arthroplasty

BackgroundEpidural volume extension (EVE) via a combined spinal–epidural is the enhancement of a small-dose intrathecal block by an epidural injection of physiological saline solution. The aim of this study was to investigate the sensory and motor block characteristics of spinal anesthesia after EVE. Eighty patients enrolled in this prospective, randomized, double-blind study. Group I (n=40) received 10 mg hyperbaric bupivacaine and group II (n=40) first received 10 mg hyperbaric bupivacaine intrathecally and subsequently 10 mL saline via epidural catheter.ResultsIn the first 30 min after combined spinal–epidural anesthesia, the maximum sensory block level was significantly higher in group II than in group I. The Bromage score was significantly higher in group II than in group I at 3–6 and 9 min of the intraoperative period. EVE increased the mean Smax significantly in group 2 than group 1 (p<0.05). Tmax was statistically similar between group 1 and group 2 (p>0.05). EVE significantly altered Time10 and Tadeq in group 2 (p<0.05).ConclusionsEVE with saline (10 mL) offer early onset of sensory and motor block and a high level of sensory block. And also delay supplemental epidural dose requirement intraoperatively.

A COMPARATIVE STUDY OF LOW DOSE INTRATHECAL DEXMEDETOMIDINE AND CLONIDINE AS ADJUVANT TO BUPIVACAINE ON CHARACTERISTICS OF SPINAL BLOCK

Background: To evaluate the effect of low dose intrathecal dexmedetomidine and clonidine as adjuvant to bupivacaine on characteristics of spinal block . A total of 60 patients , scheduled for lower abdominal , lower limb and gynaecological procedures were selected to participate in this prospective , randomised double blind study . After injecting the drug time were noted (T0) and the patient were turned to supine position . Following observation were recorded :Onset of time of sensory block(T1) ,Level of sensory block(LMAX), Time to achieve maximum sensory block level(T3), Onset of motor block(T2) , Peak level of motor blockade(T4) were assessed by using Bromage score . Results: The results of outcome variables were suggestive of improved effect of addition of clonidine or dexmedetomidine as adjuvant to 0.5 % Bupivacaine (heavy) on Quality of blockade Conclusions: Improved quality of block in dexmedetomidine group compared to clonidine can be applicable in improving the duration of block in surgical cases requiring prolonged block.

Effect of waist circumference and body mass index on the level of spinal anesthesia

BackgroundWe aimed to determine the effects of waist circumference and body mass index on spinal anesthesia levels. In total, 120 surgical patients who were between 18 and 65 years old and in the American Society of Anesthesiologists’ (ASA) I–III risk groups enrolled in this study. Patients were classified into three groups, depending on their weight. After a spinal block, we noted the time needed for the sensory block to reach the T10 level, the maximum sensory block level, the time needed for the sensory block to reach the maximum sensory block level, the time needed before the start of the motor block, and the Bromage scale for each patient.ResultsWe observed no significant demographic differences in age, gender, or ASA risk class between the groups; however, we found a statistically significant difference between the groups’ BMIs and waist circumferences. For the time needed for the spinal block to reach the T10 level, we observed a statistically significant difference between groups I, II, and III, and we also found a statistically significant difference between the groups’ comparing Bromage scales. Moreover, we found a statistically significant difference between the groups’ time needed (in minutes) for the block to reach the maximal upper dermatomal block level and, as BMIs and waist circumferences increased, the time needed to reach the maximal upper dermatomal block level. We also noted a statistically significant difference in waist circumference variability.ConclusionsThis study shows that body mass index and waist circumference can be used and interpreted as independent parameters reflecting the increasing incidence of obesity.

THE EFFECT OF EPIDURAL VOLUME EXTENSION ON SPINAL BLOCK WITH 0.5% HEAVY BUPIVACAINE IN TOTALABDOMINAL HYSTERECTOMY - A RANDOMISED CONTROLLED STUDY

Introduction: One of the indication of total abdominal hysterectomy and bilateral salpingo -oophorectomy is the patient is suffering from menometrorrhagia, excessive or irregular menstrual bleeding that occurs between or during a female's menstrual cycle. Menometrorrhagia is a indication of urogenital malignancy (such as cervical malignancy), uterine broids, hormonal discripancies and endometriosis. Other possible indications for TAHBSO are pelvic inammatory disease,ovarian cyst, cancer of overies, uterus and or cervix. If remains untreated this can lead to anemia. Aims And Objectives: Compare maximum sensory block level in each group (Smax), Period when Smax was rst achieved, Period for 2 segment regression of sensory block from its highest level, Period for block regression to level of T10 dermatome e. Maximum motor blockade achieved, Time to attain maximum motor block, Time for complete regression of motor block(modied Bromage score=6),To compare any difference in haemodynamic parameters(Spo2,mean blood pressure). Materials And Methods Study Setting:This study will be conducted in the gynaecology OTComplex of IPGME&amp;R. Study Period: March 2017-August 2018 Definition Of Problem: Comparative evaluation of the effect of epidural volume extension on spinal block with 0.5% heavy bupivacaine for total abdominal hysterectomy such as Results And Analyses: Our study showed that the distribution of body weight between Group E and Group S. Body weight was normally distributed, it was found that there was no statistical signicance difference between the groups (p=0.4054). Distribution of ASAstatus in groups, In group E 25patient were. Summary And Conclusion: This technique is, however, not without its disadvantages, which draws special attention from an anesthesiologist such as rapid rise of spinal block, accidental migration of catheter in intravascular and intrathecal space along with an increased incidence of meningitis. In future We in subsequent case series will try to highlight the efcacy of this novel technique in patients of different setting with compromised cardiac functional status.

Correlation Between Anthropometric Measurements and Sensory Block Level of Spinal Anesthesia for Cesarean Section

BackgroundWhen performing spinal anesthesia for cesarean section, it is important to determine the appropriate anesthetic dose as well as to predict the level of spinal anesthesia. In this study, it was hypothesized that some anthropometric measurements may be related to maximum sensory block and hemodynamic changes.ObjectivesThe aim of this study are to find maternal anthropometric values that are correlate with the level of spinal anesthesia.MethodsMaternal anthropometric measurements, including height, weight, supine and standing abdominal circumference (AC), and hip circumference, were recorded before spinal anesthesia for cesarean section. Spinal anesthesia was induced by administering 8 mg of 0.5% hyperbaric bupivacaine and 20 μg of fentanyl at the L3-L4 interspace. The level of sensory block was determined using pin-prick at 1, 5, 10, and 15 minutes after spinal anesthesia. The sensory block level and hemodynamic adverse events were analyzed in relationship to anthropometric measurements.ResultsThe supine AC/height ratios significantly correlate with the maximal sensory block level at 5, 10, and 15 minutes after the injection of spinal anesthetic (P = 0.001, P < 0.001 and P < 0.001, respectively). Further, there were significant correlations between body mass index (BMI) and sensory block level at every assessment (P = 0.041, P = 0.002, P = 0.001 and P < 0.001, respectively). When comparing the groups with and without hypotension, BMI, weight, and supine AC/height ratio were found to be significantly higher in the group with hypotension (P = 0.002, P = 0.004 and P = 0.006, respectively).ConclusionsWe conclude that BMI and AC/height ratio correlate with the sensory block level of spinal anesthesia for cesarean section.

Effects of Dexmedetomidine as an Analgesic Adjuvant for Surgery of Femur Fracture: A Systematic Review and Meta-Analysis

Patients who undergo surgery of femur fracture suffer the excruciating pain. Dexmedetomidine (DEX) is a unique α2-adrenergic receptor agonist with sedative and analgesic properties, whose efficacy and safety are still unclear for surgery of femur fracture. Randomized controlled trials comparing the effects of addition of DEX to general or local anesthesia in surgery of femur fracture were searched from MEDLINE, EMBASE, and the Cochrane Library database. Patients who received DEX infusion had a significant longer time to rescue analgesia compared with those without DEX coadministration. DEX treatment seemed to reduce the visual analog score; however, the significance did not reach any statistical difference. DEX as an analgesic adjuvant did not reduce the onset of sensory block time, shorten the time to achieve maximum sensory block level, and provide a longer duration of sensory block. The difference in mean sedation scores between 2 groups was not statistically significant. As for adverse effects, DEX therapy significantly increased the rate of hypotension. In conclusion, dexmedetomidine as a local anesthetic adjuvant in femur fracture surgery had a longer duration of rescue analgesia. However, the incidence of hypotension was markedly increased in these patients. It was worth noting that the evidence was of low to moderate quality.

Combined spinal epidural anesthesia in obese parturients undergoing cesarean surgery

There is asignificant increase in number of obese pregnant women worldwide. Obese parturients undergoing cesarean section have a higher risk for hypotension and require higher doses of vasopressors following spinal anesthesia compared to nonobese parturients. This study aimed to compare the maternal hemodynamic changes when combined spinal-epidural anesthesia (CSEA) is induced in the left lateral decubitus and sitting positions in obese pregnant women undergoing elective cesarean section. In this study, pregnant women with full-term gestation diagnosed as obese undergoing elective cesarean section were included. Two groups were formed: the CSEA was performed in left lateral position in groupI (n = 50) and in sitting position in groupII (n = 50). At the end of the CSEA procedure, patients were placed in the supine position. When the sensory block reached at the upper level of T6 dermatome, surgery was initiated. Hemodynamic, anesthetic and neonatal parameters were recorded. In all patients, CSEA was successful and sufficient anesthesia was provided for surgery. Time to reach T6 dermatome sensory level in groupII was found to be longer than groupI (P = 0.011). At 20 min after spinal injection, the maximum sensory block level was similar in both groups. There were no significant differences between groups in terms of sensory block time and the time to requiring postoperative supplemental analgesics. There were no significant differences in terms of the volume of intravenous fluid administered, ephedrine and atropine requirements between groups. Both groups had similar systolic blood pressure, heart rate and oxygen saturation values during surgery and postoperatively. While both groups had similar diastolic blood pressure (DBP) values during surgery and at the 1st postoperative hour, groupII had lower DBP values at the 2nd postoperative hour compared with groupI (P = 0.04). Left lateral decubitus and sitting positions during performance of CSEA lead to similar maternal hemodynamic changes in obese pregnant women undergoing cesarean section.

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

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

Assessment of Outcome of Intrathecal Analgesia in Multiparous Women Undergoing Vaginal Delivery

Background: The present study was conducted to assess the outcome of intrathecal analgesia in multiparous women undergoing vaginal delivery. Subjects and Methods: The present study was conducted among 80 multiparous women ages ranged 18- 40 years. All patients received 0.5 ml of intrathecal injection of 2.5 mg bupivacaine 0.5% and 1 ml dexamethasone 4 mg plus a 0.5 ml adjuvant. The adjuvants in group I patients were 100 μg morphine, 25 μg fentanyl in group II, 5 μg dexmedetomidine in group III and normal saline in group IV (control group). The primary and secondary outcome was the duration of pain relief, the analgesia onset time, the maximum level of sensory block, the visual analogue scale (VAS) was recorded. Results: The mean duration of analgesia in group I was 182.4 minutes, in group II was 170.5 minutes, in group III was 200.4 minutes and in group, IV was 140.2 minutes. The onset of analgesia was 3.9 minutes, 2.8 minutes, 2.7 minutes and 4.5 minutes in group I, II, III and IV respectively. S1 sensory regression time (minutes) was 181.4, 157.4, 185.3 and 130.6 in group I, II, III and IV respectively. Modified Bromage scale 5 minutes, 15 minutes and 30 minutes after IT in all groups was 0.0. VAS was 1.3, 1.6, 1.6 and 3.1 with significant differences in all groups (P&lt; 0.05). There was non- significant difference in mean age, weight, height and gestational age between all groups (P&gt; 0.05). There was a non- significant difference in APGAR 1, 5, umbilical pH immediately after delivery, neonatal HR after 5minute, 15 minutes and 30 minutes in all groups (P&gt; 0.05). Conclusion: The authors found that dexmedetomidine is a safe and effective adjuvant to intrathecal bupivacaine-dexamethasone in multiparous women undergoing normal vaginal delivery.

Comparison of Two Doses of Chloroprocaine for Spinal Anaesthesia in Brachytherapy Procedures: A Randomised Clinical Study

Introduction: Subarachnoid block is a widely used anaesthetic technique for lower abdominal and lower limb surgeries. Commonly used local anaesthetics are with longer duration of action and delayed recovery. Chloroprocaine is good choice for day care procedures because of its reliable action, faster resolution of block and earlier discharge time. Aim: To compare the minimum effective dose of chloroprocaine for spinal anaesthesia in brachytherapy. Materials and Methods: A total of 140 carcinoma cervix patients of ASA class I and II of age group 18 to 60 years were randomly divided into two groups of 70 each. They were posted for elective brachytherapy procedure under subarachnoid block. Group A patients received 2 mL of chloroprocaine (20 mg) and Group B patients received 3 mL of chloroprocaine (30 mg). Parameters like onset of sensory and motor blocks, maximum level of sensory block, time for two segment regression, duration of block and haemodynamic parameters were studied for the duration of procedure. Data were analysed using SAS 9.2, SPSS 15.0 software version. Descriptive and inferential statistical analysis was carried out. Results on continuous measurements are presented as mean±SD (min-max) and results on categorical measurements are presented in number (%). Significance was assessed at 5% level of significance. Results: Patients in both the groups were comparable with respect to the demographic characteristics. There were statistically significant differences in time for onset of motor blockade, duration of motor and sensory blockade, time for two segment regression which were shorter in chloroprocaine 20 mg (group A) compared to chloroprocaine 30 mg (group B). Haemodynamic variations and incidence of side-effects were similar in both groups. Conclusion: Subarachnoid 2-chloroprocaine (30 mg) provides adequate duration and density of spinal anaesthesia for brachytherapy procedures as compared with 20 mg 2-chloroprocaine.

A randomized controlled trial on epidural volume extension in combined spinal epidural anesthesia for lower limb surgeries using intrathecal ropivacaine in older adults

Background: Epidural volume extension (EVE) is a technique wherein normal saline is injected into epidural space, soon after the neuraxial block. We studied the effectiveness of EVE using intrathecal ropivacaine and normal saline in the elderly. Patients and Methods: This was randomized, control, double-blinded, double arm, parallel study of 75 patients of American Society of Anesthesiologists I and II, age ≥60 years, undergoing lower limb orthopedic surgery. Patients were allocated into two groups (E and NE), both receiving 3 ml of 0.75% injection ropivacaine intrathecally. Group E also received EVE. The primary outcome was the maximum level of sensory block. Secondary outcomes were the characteristics of blocks, hemodynamic changes, adverse effects, and analgesic requirements until 24 h. The statistical analysis of quantitative data was done by the Student's t-test and that of qualitative data using the Chi-square test. Results: The sensory level of block achieved in Group E T4(T2–T5) was higher as compared to Group NE, T6(T3-T8). Time to two-segment sensory regression was earlier in Group NE (mean = 66.5 min; 95% confidence interval [CI], 63.31–69.69) than in Group E (mean = 91.5 min; 95% CI, 87.70–95.31) (P < 0.001; df = 58). The duration of analgesia in Group E (mean = 316.5 min; 95% CI, 309.09–323.91) was more than in Group NE (mean = 230.67 min; 95% CI, 226.49–234.850) (P < 0.001). There was no statistically significant difference in the 24 h analgesic consumption (P = 0.64), hemodynamic stability, or adverse effects. Conclusion: EVE results in a higher level of the sensory block and a longer duration of postoperative analgesia than that without EVE with no hemodynamic instability in the older population.

What is the optimal dose of intrathecal meperidine in open prostate surgery? A prospective double-blind randomized study.

This study was an analysis of the effect of different dosages of intrathecal meperidine (40 mg, 50 mg, 60 mg, and 70 mg) on hemodynamic parameters, the duration of neural blockade, and the incidence of meperidine-related side effects in patients who underwent an open prostatectomy. Sixty patients who underwent an open prostatectomy with combined spinal-epidural anesthesia were included. The patients were allocated to receive 1 of 4 different dosages of intrathecal meperidine (n=15 for each group): Group I: 40 mg, Group II: 50 mg, Group III: 60 mg, and Group IV: 70 mg. The duration of the block procedure, surgery duration, highest sensory block level, and anesthetic complications were recorded and analyzed. At 20 minutes after the spinal injection, the maximum sensory block level was T6 in Group I and II, and it was T5 in Group III and IV. The mean motor block scores at 20 minutes after the spinal injection were lower in Group I compared with the other groups (p<0.001 for all). The motor block duration was significantly shorter in Group I and II than in Group III and IV (p<0.001 for all). Surgeon satisfaction was greater in Group II, III, and IV compared with Group I (p<0.001 for all). Patient satisfaction was better in Group III and IV compared with Groups I and II (p<0.001 for all). Intrathecal meperidine at a dose of 60 mg exerted a sufficient analgesic effect with minimum side effects in patients undergoing open prostatectomy.

Effectiveness of Hyperbaric Ropivacaine over Hyperbaric Bupivacaine in Spinal Anaesthesia

Introduction: Spinal anesthesia is widely recognized as an alternative to general anesthesia for the surgery in lower extremities, perineum or lower body wall. The aim of the study was to compare the effectiveness and safety of hyperbaric Bupivacaine over hyperbaric Ropivacaine .&#x0D; Materials and Methods: We enrolled 60 patients of either sex, ASA grade I &amp;II who were randomly allocated in two groups. Group-B received 3 ml of 0.5% hyperbaric Bupivacaine with glucose 8% and Group-R received 3ml of 0.5% hyperbaric Ropivacaine glucose 8.33%. The various parameters of the subarachnoid block, hemodynamic variables, recovery from sensory and motor blockade and side effects were studied.&#x0D; Result: The time to onset of maximum sensory block level was faster in Bupivacaine (9.10±3.90min) than in Ropivacaine (10.87±5.37min) and statistically not significant. The time to 5 segments regression was faster in Ropivacaine (116.00±29.72min) than Bupivacaine (143.50±18.76min) and the time to S2 level regression of sensory block was faster in Ropivacaine (154.00±27.84min) than Bupivacaine (186.00±18.73min). The time to onset of the maximum motor was faster with Bupivacaine (8.70±3.19min) as compared to Ropivacaine (13.10±4.40min) The time to regression of motor block by 1 grade was faster with Ropivacaine (97.00±26.64min) than Bupivacaine (146.50±23.53min) and the time to complete regression of motor block was faster with Ropivacaine (149.00±30.75min) than Bupivacaine (183.50±19.96min).&#x0D; Conclusion: The hyperbaric Ropivacaine (3ml, 0.5%) provides a reliable subarachnoid block of shorter duration than hyperbaric Bupivacaine (3ml, 0.5%) with stable hemodynamic parameters.

Effects of Intrathecal Bupivacaine and Bupivacaine Plus Fentanyl in Elderly Patients Undergoing Total Hip Arthroplasty.

To determine and compare the clinical efficacy of spinal anesthesia with bupivacaine combined with fentanyl and bupivacaine alone in geriatric patients scheduled for total hip arthroplasty (THA). Experimental study. Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China, from April 2016 to April 2017. Sixty-five geriatric patients were randomised into two groups. Group B was anesthetised with 0.5% bupivacaine 10 mg and Group F with 0.5% bupivacaine 7.5 mg plus fentanyl 20 μg. Hemodynamic stability, effect and satisfaction of anesthesia, time to the first postoperative analgesic requirement, adverse effects, and incidence of postoperative indwelling catheter were compared. There was no significant difference in time to reach maximum sensory block level, maximum sensory block level, maximum motor block, duration of motor block, quality of anesthesia, adverse effects or the incidence of postoperative indwelling catheter between the two groups. However, Group F required less dosage of ephedrine for stable hemodynamics and longer time to use the primary postoperative analgesic in comparison to Group B (p<0.05). Adding 20 μg fentanyl to a lower dose of 7.5 mg bupivacaine can provide safe and effective spinal anesthesia for THA in geriatric patients.