Maximum Sensory Block Research Articles

Comparative Study of Injection Butorphanol Versus Injection Fentanyl with Injection Ropivacaine in Ultrasound Guided Supraclavicular Block to Evaluate Sensory and Motor Block Characteristics

BACKGROUND Regional anaesthetic technique has many advantages over general anesthesia. The supraclavicular brachial plexus block due to its rapid onset and reliability offers dense anesthesia of brachial plexus for surgeries at or distal to elbow. The additives like injection Fentanyl and injection Butorphanol along with 0.5% injection Bupivacaine have been proved to be efficient for supraclavicular block. However their effects haven't been compared by using them as additives in 0.5% Injection Ropivacaine. Aims To compare the sensory and motor block characteristics of injection Butorphanol and injection Fentanyl in injection Ropivacaine. METHODS This prospective single blinded randomised control study included 60 patients (ASA I or II; 18- 60 yrs) scheduled for upper limb surgeries. Patients were randomly allocated to two groups of 30 each and supraclavicular block was given as per distribution (Group B: 30 ml 0.5 % injection Ropivacaine with 2mg injection Butorphanol and Group F: 30 ml 0.5 % injection Ropivacaine with 100 mcg injection Fentanyl). The hemodynamic parameters were recorded at baseline, post block and till 45 mins. Sensory and motor block assessments were done along with sedation score determination. Duration of sensory and motor block was noted. RESULTS The group with injection Fentanyl as additive had earlier onset of motor blockade. Time required to achieve sensory blockade was less in Group F. Duration of sensory and motor block prolonged in Group F. CONCLUSIONS Injection Fentanyl as additive in injection Ropivacaine provided earlier onset of motor block and decreased total time required to achieve maximum sensory block with prolonged duration and decreased requirements of rescue analgesia.

Effect of Abdominal Girth and Vertebral Column Length in Spread of Spinal Anesthesia for Lower Limb Surgery: A Prospective Study

Background: Subarachnoid spread of local anesthetics is quite erratic and is determined by several factors. There is a high predictive for the spread of spinal anaesthesia in terms of abdominal girth and vertebral column length. Our study is designed to determine the effect of abdominal girth and vertebral column length with cephalad spread of spinal anaesthesia for a given dose of 0.5% hyperbaric bupivacaine in Nepalese patients. Materials and Methods: In this prospective observational study, a total 100 patients of ASA PS I-II, aged16-65 years and undergoing lower extremity surgery under spinal anesthesia were enrolled. 2.8 mL of 0.5% hyperbaric bupivacaine was injected intrathecally at L3-4 interspace in sitting position. Extent of sensory blockade was assessed for 60 min. Simple linear regression, multiple linear regression and Pearson’s correlation coefficient analysis were performed to determine the correlation between patient variables viz abdominal girth, vertebral column length, height, weight, body mass index and age and maximum sensory block height. Results: Abdominal girth and vertebral column length correlated significantly with the maximal sensory block height after intrathecal administration of a fixed dose of 0.5% hyperbaric bupivacaine by all the three statistical tools used. Conclusion: Abdominal girth and vertebral column lengthcorrelate significantly with the maximal sensory block height in Nepalese patients receiving a fixed dose subarachnoid block with 0.5% hyperbaric bupivacaine

Comparison of sequential and mixture injections of opioids and hyperbaric bupivacaine for subarachnoid block for lower segment caesarean section: a randomised controlled study.

Opioids are commonly added to local anaesthetic for subarachnoid block for caesarean section due to their synergistic effects. The physiochemical characteristics of opioids suggest premixing with hyperbaric bupivacaine may limit their distribution within the CSF. We studied the effect of a separate injection with a combination of bupivacaine, morphine and fentanyl on block characteristics, haemodynamic changes, postoperative pain and patient satisfaction. Following ethical approval and informed consent, a prospective double-blinded randomised controlled trial was performed in a university hospital. A total of 126 patients undergoing caesarean section were randomised to two groups. In group M, the premixed group, patients received 12mg of hyperbaric bupivacaine, 20 mcg of fentanyl and 100 mcg of morphine injected as a single mixture. In group S, the separate injection group, patients received the same drugs in separate injections. Measurements included haemodynamics, block distribution, intra- and postoperative pain, as well as patient satisfaction. Patients in both groups had similar block height, time to maximum sensory block, time to block regression and motor block. However, haemodynamics were different between the groups. The proportion of systolic hypotension episodes was greater in group S [159/1320 (12.05%)] than group M [113/1452 (7.78%)], with P = 0.0002. Moreover, a greater amount of ephedrine was administered in group S than group M, with values 12.09 (8.1) and 9.09 (8.5) mg respectively (P = 0.001). Additionally, postoperative pain, as measured by the Visual Analogue Scale (VAS), was greater in group M, with a VAS of 4.6 (1.7), vs. group S, which recorded a VAS of 3.8 (2.0) (P = 0.017). Sequential injection of intrathecal opioids and hyperbaric bupivacaine resulted in greater early haemodynamic instability and slightly better postoperative analgesia without any difference in block height or patient satisfaction. NCT04403724.

Do you mind the role of spinal sensory block duration in a crucial endocrine disorder of diabetes mellitus? A prospective observational study.

Diabetes mellitus, per se, is a global health concern, which is often accompanied by complications such as diabetic neuropathy. This prospective observational study purposed to assess the durations of spinal sensory block and motor blocks in individuals with and without diabetes mellitus who had undergone spinal anesthesia. This study incorporated 80 cases, which were evenly divided into spinal sensory block without diabetes mellitus and spinal sensory block with diabetes mellitus. Various parameters were recorded at different time points, including heart rate, mean arterial blood pressure, SpO2, and spinal block characteristics. Notable measures included maximum spinal sensory block onset time, time to reach the 10th thoracic vertebra (T10), maximal spinal sensory block, time for Bromage scores, and block regression while controlling for age-related variations. Patients in the diabetic group exhibited extended block durations, with significant differences in heart rate noted at specific time points. Regarding the spinal block characteristics, the "maximum onset of SSB" and the "time to reach the T10" were more prolonged in the SSBwDM without significance. Maximum sensory spinal sensory block did not differ. However, some cases in the SSBwDM displayed blocks extending up to the T6. The times to achieve Bromage motor block scores 1-3 were shorter in SSBwDM and lost significance regarding age. Notably, the regression time was longer in SSBwDM, which held significance for both parameters. Diabetic cases commonly encounter prolonged block durations post-subarachnoid intervention, potentially linked to nerve sensitivity, age-related changes, and glycemic control. As such, attenuated local doses for diabetic neuropathic cases may enhance early mobilization, attenuate thromboembolic events, and expedite gastrointestinal recovery.

Study of effectiveness of two syringe spinal anaesthesia technique for caesarean section

Spinal anaesthesia using hyperbaric bupivacaine is the most popular method for caesarean section. Adjuvents like fentanyl which enhances the sensory block and provide stable haemodynamics are usually premixed with bupivacaine in a single syringe. Fentanyl when added to hyperbaric bupivacaine, decreases the density of solution to extent of 0.0006 which alters the spread of local anesthetics in CSF. If we inject both the drugs separately in different syringe, it may minimize the effect of the changes in densities and PH of both the drugs and produce their maximum effect with minimal haemodynamic alteration. Therefore this study was conducted to see the quality of sensory block and haemodynamic response by sequential intrathecal administration of fentanyl and hyperbaric bupivacaine in two different syringe for patients undergoing caesarian section. This interventional study was carried out in Seventy nine Patients undergoing caesarean section under spinal anesthesia with 0.5% hyperbaric bupivacaine 9mg (1.8 ml) and fentanyl 20 mcg in two different syringe administered sequentially. Out of 79 parturients only 22 (27.85%) had hypotension requiring vasopressor treatment during caesarean section and maximum amount of vasopressor used was 15 mg of mephentermine. The mean level of maximum sensory block after 20 mins of spinal anaesthesia was T2 in 20 (25.32%) patients, T3 in 19 (24.05%) patients, T4 in 32 (40.51%) patients, T5 in 1 (1.27%) patient and T6 in 7 (8.86%) Patients. Intraoperative quality of surgical anaesthesia was very satisfactory to the patients. Only 6 (7.59%) patients had mild discomfort whithout requirement of any medical treatment. The result of this study concluded that separate intrathecal injection of fentanyl and hyperbaric bupivacaine provides better haemodynamic stability, improves quality of surgical anaethesia allowing it to work at higher levels in the spinal cord with minimal other side effects in patient undergoing caesarean section.

Effects of Hyperbaric and Isobaric Bupivacaine on Hemodynamic Profiles and Block Characteristics Among Parturients Undergoing Elective Cesarean Section Under Spinal Anesthesia: A Randomized Controlled Trial.

Cesarean section (CS) is a surgical procedure where the baby is delivered through incisions made in the abdomen and uterus. Bupivacaine is a widely recognized local anesthetic available in different baricity and it is frequently used for spinal anesthesia. The baricity of bupivacaine impacts hemodynamic profiles and block characteristics. To compare the effects of hyperbaric and isobaric bupivacaine on hemodynamic profiles and block characteristics among parturients undergoing elective cesarean section under spinal anesthesia at Dilla University Referral Hospital. 64 pregnant mothers scheduled for elective cesarean section under spinal anesthesia were randomly assigned to two groups: Group A received a dose of 12.5 mg of isobaric bupivacaine (n = 32), Group B received a dose of 12.5 mg of hyperbaric bupivacaine (n = 32). Prior to conducting the study, the necessary ethical approvals were obtained. For comparing numerical variables between the two groups, the independent Sample t-test or Mann-Whitney U-test was employed as needed. Repeated measurements were analyzed using mixed ANOVA. Categorical variables were assessed using either the chi-square test or Fisher's exact test. Statistical significance was set at P < 0.05, with a power of 90%. The mean Systolic Blood Pressure (SBP), Diastolic Blood pressure (DBP), and Mean Arterial Blood Pressure (MAP) showed significant decrement in the group receiving isobaric spinal anesthesia compared to those receiving hyperbaric bupivacaine. The decrement was observed from the 6th to 30th minute (p<0.05). Furthermore, the hyperbaric group had a faster onset time for achieving the maximum sensory block, with a median time of 3 (1) min compared to 4 (2) mins in the isobaric group (p<0.001). We conclude that hyperbaric bupivacaine provides stable intraoperative hemodynamic parameters and an earlier onset of block than isobaric bupivacaine. Therefore, we recommend clinicians to use hyperbaric bupivacaine for cesarean delivery.

Intrathecal bupivacaine with fentanyl compared to levobupivacaine with fentanyl for painless labor: a double-blind, randomized clinical trial

Background &amp; Objective: Labor pain relief has been a challenge for the clinicians for centuries. A lot many regimes and therapeutic interventions, including spinal and epidural injections, have been tried with variable effect. We aimed to compare the duration of analgesia and potency of bupivacaine plus fentanyl vs. levobupivacaine plus fentanyl for painless labor.&#x0D; Methodology: We enrolled 70 parturients who requested spinal analgesia in active labor, and randomly divided them into two groups; Group B (35 women) received 2.5 ml of bupivacaine 0.5% plus fentanyl 25 µg, and Group L (35 women) received 2.5 ml of levobupivacaine 0.5% plus fentanyl 25 µg. We assessed motor and sensory block, the efficacy of analgesia, pain scores, adverse effects, and obstetric and neonatal outcomes of both groups.&#x0D; Results: Time to reach maximum sensory block was significantly longer in Group L than in Group B (P = 0.002*). There was a statistically significant increase in the duration of motor blocks in Group B than in Group L (P &lt; 0.05). The median VAS scores were significantly lower in Group L than in Group B after 2 and 3 h after injection. The duration of analgesia was significantly longer in Group L than in Group B (P &lt; 0.05). The two study groups had no differences in the measured obstetric and neonatal outcomes.&#x0D; Conclusion: Levobupivacaine with fentanyl was superior to bupivacaine with fentanyl regarding the duration and potency of analgesia with lower pain scores, high maternal satisfaction, and no adverse obstetric or neonatal outcomes. Therefore, spinal levobupivacaine plus fentanyl was a reasonable choice for labor analgesia and can be used without jeopardizing the safety of the mother and fetus.&#x0D; Key words: Bupivacaine; Fentanyl; Levobupivacaine; Labor pain; Spinal Analgesia&#x0D; Citation: Ali WN, Youssef HA, Abbas AM, Roshdy PE, ImbabyASS. Intrathecal bupivacaine with fentanyl compared to levobupivacaine with fentanyl for painless labor: a double-blind, randomized clinical trial. Anaesth. pain intensive care 2023;27(4):478−484; DOI: 10.35975/apic.v27i4.2256&#x0D; Received: July 29, 2022; Reviewed: April 19, 2023; Accepted: April 21, 2023

COMPARATIVE EVALUATION OF EPIDURAL BUPIVACAINE WITH MAGNESIUM SULPHATE AND LEVOBUPIVACAINE WITH MAGNESIUM SULPHATE IN GERIATRIC AGE GROUP IN LOWER LIMB SURGERIES

Introduction :Bupivacaine is local anaesthetic drug consist of R &amp; S enantiomers. Levobupivacaine a cardiostable S enantiomer of Bupivaciane. Magnesium sulphate a promising noncompititive blocker of NMDA receptor by inhibition calcium Inux in cell. We want to study addition of Magnesium Sulphate to both Bupivacaine 0.5% &amp; Levobupivacaine 0.5% for epidural anaesthesia in lower limb surgeries. to compare efcacy of epidural Inj. Bupivac Aims &amp; Objectives: aine 0.5% plus Magnesium sulphate with Inj. Levobupivacaine 0.5% plus Magnesium Sulphate on onset of sensory &amp; motor blockade, intraoperative hemodynamics , requirement of rst analgesiac &amp; side effects in elderly patients posted for lower limb surgeries. A randomised prospective double blind Material and Method: study in 60 geriatric patient posted for lower limb surgeries. After epidural space identication Inj. Bupivacaine 0.5% 14 ml + 50mg MgSo4 in 1 ml NS in group B or Inj. Levobupivacaine 0.5% 14 ml + 50mg MgSo4 in 1 ml NS in group L. Onset of sensory blockade and motor blockade, two segment regression, demand of rst analgesic, intraoperative hemodynamics and postoperative complications were documented and compared Observation: Mean time required for onset of sensory block was 6.27±1.48 min in Group B and 6.3±1.76 min in group L respectively. onset motor block times of 7.43±1.38 in group B while 8.13±1.81 mins in group L which were No statistically signicant difference. Group L required 20.1±4.87 mins for reaching maximum sensory block compared to 13.33±2.17 mins in group B which was statistically signicant difference with early achievement of higher sensory level in group B. The time required for two segment regression was longer, at 133±19.01 minutes in group B compared to 114.47±10.28 minutes in the group L which found statistically signicant difference. Group B required rst analgesics quite latter 241.33±29.39 at mins compared to 203±20.54 mins in group L. This was found to be statistically signicant difference indicating that Bupivacaine is having longer duration of analgesia compared to Levobupivacaine. 3 patients had hypotension in group while 1 in group L. Shivering noticed 6 in Group L compared to 3 in group B. vomiting in 3 patients in each group.only 1 patient had itching in group b. Intraoperative hemodynamic parameters were having statistically insignicant difference. Conclusion: We can conclude that effect of Magnesium sulphate as an additive to Levobupivacaine and Bupivacaine provide good haemodynamic and respiratory stability, Comparable onset of sensory and motor blockade with prolongation of postoperative analgesia in bupivacaine group indicating that Bupivacaine with Magnesium sulphate provides prolonged analgesia as compared to Levobupivacaine with Magnesium Sulphate.

Comparison of Intrathecal Bupivacaine with Levobupivacaine using Fentanyl as an Adjuvant for Transurethral Resection of Prostate-A Randomised Controlled Trial

Introduction: Transurethral Resection of Prostate (TURP) is a common surgical procedure performed for Benign Prostatic Hypertrophy (BPH), most commonly under Spinal Anaesthesia (SA). It is generally tolerated well by the elderly but since they suffer from several co-morbidities, therefore, it is desirable to avoid hypotension following SA, in these patients. Levobupivacaine, a pure S enantiomer of racemic bupivacaine has emerged as a safe alternative to bupivacaine with similar efficacy and better pharmacokinetic profile. Aim: To compare the efficacy of intrathecal levobupivacaine with bupivacaine using fentanyl as adjuvant in TURP. Materials and Methods: This randomised controlled trial was conducted at Pandit BD Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India, between March 2022 to September 2022. Fifty patients, 50-80 years of age, American Society of Anaesthesiologists (ASA) I-III, posted for TURP under SA, were included in the study and divided into two groups: group B (n=25): Inj. bupivacaine (0.5%) hyperbaric 12.5 mg+25 µg fentanyl citrate, group L (n=25): Inj. levobupivacaine (0.5%) isobaric 12.5mg+25µg fentanyl citrate. Onset of sensory and motor block, time to onset of maximum sensory and motor block, Heart Rate (HR), Systolic Bood Pressure (SBP), Diastolic Bood Pressure (DBP) and Mean Arterial Pressures (MAP) were recorded. Data analysis was done with the help computer software using Statistical Package for the Social Sciences (SPSS), version 24.0. Means, standard deviations, Chi-square, t-values and p-values were calculated, p-value &lt;0.05 was considered significant at 95% confidence level. Results: Demographic data of the patients was comparable. The mean time to onset of sensory block in group B was significantly faster (3.72±0.96 min) than group L (4.47±0.73 min). The mean time to onset of motor block was faster in group B (4.74±0.91 min) than group L (7.57±1.51 min). HR was lower in group B, after SA at 5, 10, 15, 20, 30, and 45 min after SA. Group B recorded a lower SBP, DBP and MAP following SA, compared to group L (p&lt;0.001). The duration of analgesia was significantly longer in group B (232.80±14.07 min vs 221.80±15.47 min in group L) (p&lt;0.05). No adverse effects were reported from either of the groups. Conclusion: Levobupivacaine provided very stable haemodynamics, good quality analgesia and muscle relaxation intraoperatively. Postoperative analgesia was clinically similar to bupivacaine, no adverse effects were reported. Thus, levobupivacaine is a safe and reliable alternative to bupivacaine for elderly patients undergoing TURP

A Comparison Between Intrathecal Levobupivacaine and Bupivacaine for Quality and Safety During Infraumbilical Surgeries.

Background Levobupivacaine toxicity reports are rare, and when they do occur, toxic symptoms are frequently treatable with minimal morbidity and mortality. However, levobupivacaine has not entirely replaced bupivacaine in clinical practice. Moreover, the experience of intrathecal anesthesia with levobupivacaine is not well documented. Hence, the purpose of this study is to assess the quality and duration of sensory and motor blockade of levobupivacaine and its side effects, if any, compared to intrathecal bupivacaine during infraumbilical surgeries. Methods After approval by the Institutional Ethical Committee of Kurunji Venkatramana Gowda (KVG) Medical College and Hospital, Sullia, 90 patients aged between 18 and65 years, of either sex, who were scheduled for elective abdominoperineal, urological, or lower limb surgeries under intrathecal anesthesia were enrolled in this prospective study fromJanuary 2013 to June 2014. The selected patients were randomly assigned to three groups of 30 each: group HB (3 mL of 0.5% hyperbaric bupivacaine), group IB (3 mL of 0.5% isobaric bupivacaine),and group IL (3 mL of 0.5% isobaric levobupivacaine). Motor blockade was assessed using the modified Bromage scale. Intergroup comparison was done using Tukey's post hoc test. The incidence of adverse effects was analyzed using a chi-squared test. Significance was defined as P<0.05. Results In our study, the mean age of patients in the three groups was comparable (P>0.05), i.e., group IB was 39.23±11.78 years, group HB was 43.63±11.33 years, and group IL was 39.8±12.07 years. The time of onset ofsensory block was 6.57±1.794 minutes in group IB, 2.30±1.343 minutes in group HB, and 4.57±1.960 minutes in group IL, and this variation was statistically highly significant (P<0.001). A total of 15 patients suffered hypotension intraoperatively, of which eight belonged to group HB, four to group IB, and the rest to group IL. Intraoperative or postoperative nausea/vomiting was seen in five patients in group IB, two patients in group HB, and one patient in group IL. In the postoperative period, the mean heart rate (HR) was 77.47±4.88/minute in group IB, 68.78±7.88/minutein group HB, and 72.15±8.83/minute in group IL. The data was statistically highly significant (P<0.001). Conclusion Our study revealed that 15 mg of isobaric levobupivacaine (3 mL of 0.5%), the new racemic isomer of bupivacaine, was intermediate in its anesthetic properties when compared to isobaric bupivacaine and hyperbaric bupivacaine. The onset of sensory and motor blockade is slower than hyperbaric bupivacaine but faster than isobaric bupivacaine with a higher level of maximum sensory block.

Role of Pregabalin in Reducing Postoperative Analgesic Requirement of Patients Undergoing Knee Arthroscopy Anterior Cruciate Ligament Repair

Objective: To assess the effect of pregabalin in reducing the postoperative requirement of analgesics of patient undergoing knee arthroscopic anterior cruciate ligament repair surgery. Study Design: Prospective randomized control trial. Place and Duration of Study: Department of Anesthesia, Ghurki Trust Teaching Hospital Lahore from 1st June 2021 to 31st December 2021. Methodology: Eighty patients were randomly divided into two groups; group A and group B, each group comprised 40. Group A receive placebo and group B receive pregabalin 150mg once a day for two days after surgery. Pain assessment done with the help of Numeric Rating Scale and rescue analgesia was recorded. Results: The mean age was 31±10.2 years of group A and 33±10.3 year of Group B. There were more males within both groups in comparison to females with a percentage of 77.5% and 85% respectively. The reduction was seen within Group B in comparison of Group A in terms of ASA class, VNRS, and maximum sensory block. Cumulative volume of PCA in ml was also less in group B than group A with a significant difference within 0-6 hours. Conclusions: The use of pregabalin 150mg after surgery for two days significantly reduces the analgesic consumption Keywords: Pregabalin, Postoperative analgesic, Numeric rating scale

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.

Effect of Intrathecal Dexmedetomedine as Adjuvant to Bupivacaine in Caesarian Section: A Double Blind Study

Aim: To explore the impact of dexmedetomedine as adjuvant to hyperbaric bupivacaine 0.5% in spinal anaesthesia in caesarian section. Methods: This study was conducted in Services Hospital, Lahore from 23-2-21 to 31-05-21. Two groups of 30 each were made by dividing patients randomly. Group B was given hyperbaric bupivacaine 0.5% (10mg) diluted in normal saline and in Group BD dexmedetomedine 5µg (0.5 ml) was added to 10mg hyperbaric bupivacaine (0.5%). Spinal Anaesthesia was administered with 25G spinal needle. Haemodynamic changes, onset and duration of sensory and motor block were documented. Inadequate perioperative analgesia was relieved with ketamine. Comparison of hemodynamics was done by independent sample t-test. Characteristics of motor and sensory block, analgesic time period were all presented as median (IQR) and compared by Mann Whitney U test. Comparison of categorical variables was done by Chi square. p&lt; 0.05 was considered significant. Results: The median time for sensory block onset was 2.0(2.0 - 3.0) in Group B vs 2.0(2.0 - 3.0) BD. The median time to reach maximum sensory block was not significantly different. (p-0.151). The two segment sensory regression time was significantly longer in group BD with median time 2.2(2.0 – 3.0) vs 1.5(1.3 – 2.0) hours in group B. Significant increase in analgesic duration was seen in group BD (p&lt;0.001). Onset of motor block was higher in group BD significantly (p-0.04). Significant increase in motor block duration was seen (p&lt;0.05) in BD vs B group with respective median times 6.0(5.5 – 7.0) and 3.5(3.0 – 4.0). Conclusion: Intrathecal Dexmedetomidine 5 µg with hyperbaric bupivacaine significantly prolongs both sensory and motor block and prolongs the duration of analgesia in lower segment caesarian section. Keywords: Dexmedetomedine, Spinal Anaesthesia, Sensory block, Motor block

A study to compare 0.5% hyperbaric bupivacaine with 0.5% isobaric ropivacaine intrathecally for elective lower limb surgery.

Background: Spinal anaesthesia is the most appropriate method that is more advantageous than general anaesthesia. The study was planned to comparatively assess the effects of hyperbaric 0.5% Bupivacaine with isobaric 0.5% Ropivacaine in Elective Lower Limb Surgery. Methodology: One hundred patients belonging to American Society of Anesthesiologists (ASA) class I and II were selected for elective lower segment operation. Participants were assorted into two groups without following any fixed criteria and treated as; Group B and R, injected with bupivacaine in 0.5% hyperbaric condition and 0.5% isobaric ropivacaine, respectively. Results: The time of onset of blockage of sensation was prominently lesser in Group B contrary to Group R. The time slot of attainment of maximum sensory block up to T6 level was statistically significant and was smaller in Group B. The duration for the two-segment regression's sensorial blockage was more duration in Group B. The average extent of blockage of sensation was lesser in the R group. The time to achieve maximum motor blockage when testing via Bromage scale 2 was lower in the B group. In group B, the mean duration of the motor blockade was calibrated from the Bromage scale. Conclusion: The use of ropivacaine given for lower segment surgeries provided an efficient level of block required during the surgery with a speedy outset of motor and sensory blockade and less time needed to achieve motor blockade.

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.

Onset Time of Spinal Anaesthesia in Pregnant Females in Knee-Chest Position: A Randomized Controlled Study

ObjectiveTo assess the efficacy of knee-chest position in shortening the time of spinal induction in pregnant women undergoing elective cesarean section. We also assessed for any untoward adverse events that might limit their usefulness in real-life clinical scenarios.MethodsProspective, randomized controlled study was done in maternity operating room of tertiary care institution in 45 ASA II pregnant women undergoing elective cesarean section under spinal anaesthesia. Patients were randomly assigned to groups S (supine) and K (knee-chest position). After performing subarachnoid block (9 mg of 0.5% hyperbaric bupivacaine and 25 µg fentanyl) in the sitting position, women in group K were maintained in the knee-chest position for 60 seconds. Time to attain block height of T6 and maximum sensory blockade, intraoperative hemodynamics, Bromage score, intraoperative fluid, vasopressor requirement, and respiratory parameters were recorded. The newborn was evaluated using Apgar scores at 1 and 5 minutes.Results: Data of 45 patients were analyzed. Time to attain T6 block height (group K = 2.1 ± 0.65 minutes, 95% CI: 1.83-2.39; group S = 6.4 ± 0.77 minutes, 95% CI: 6.10-6.78) and time to achieve maximum sensory block height were significantly lower in group K (group K = 3.2 ± 1.35 minutes, 95% CI: 2.61-3.78; group S = 6.6 ± 0.89 min, CI: 6.19-6.98). The degree of motor block was higher in group K than that of group S at 2 minutes (P = .0002), 4 minutes (P < .0001), and 6 minutes (P < .0001), with no difference at 8 minutes. No statistically significant difference was observed in fluids and vasopressors requirement intraoperatively.ConclusionsThis study provides evidence that the onset of adequate surgical anaesthesia for the cesarean section can be hastened by placing the patient in the knee-chest position for a minute after performing the subarachnoid block in the sitting position.

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.

English

BACKGROUND Bupivacaine being an amide is used in hyperbaric and isobaric forms as a spinal anaesthetic for surgeries requiring regional anaesthesia. Spinal anaesthesia is an accepted form of anaesthesia for elective and emergency caesarean sections. Bupivacaine used in spinal anaesthesia produces analgesia, anaesthesia, and motor block. Grading the effects of the anaesthetic is based on volume, concentration, and dose. The present study analysed the role of both types of bupivacaine supplemented by fentanyl. Here we wanted to study the anaesthetic effects of isobaric levobupivacaine versus hyperbaric bupivacaine where both were supplemented by fentanyl while being used as a spinal anaesthetic in patients operated for caesarean section. METHODS A prospective double-blind study was conducted on 104 women undergoing caesarean sections under spinal anaesthesia at Viswabharathi Medical College, RT Nagar, Penchikalapadu, Kurnool. Women with gestational age of above 37 weeks were included. Patients were classified into Group A: levobupivacaine 10 mg 0.5 % in 2 ml with fentanyl 25 μg in 0.5 ml used intrathecally; Group B: Hyperbaric bupivacaine 10 mg 0.5 % in 2 ml with fentanyl 25 μg in 0.5 ml used intrathecally. The time for maximum sensory block, time regression of sensory block to two dermatomes, the time taken to r for regression from maximum to T12 were recorded. A Bromage scale (modified) helped to assess the motor block. Time taken for onset of motor block, the time taken to reach Bromage 3 and the time of complete disappearance were recorded. RESULTS The onset of sensory block was late in group A compared to group B. The time taken to reach the T10 sensory block was shorter in group B compared to group A, the time taken to reach T4 was longer in group A and shorter in group B. The time for regression of two dermatomes was longer in group B when compared to group A. The total duration of sensory blockade was longer in group B than in group A. The time of onset of motor block in Group B was shorter than in Group A. CONCLUSIONS Both levobupivacaine and hyperbaric bupivacaine provided quick and desirable induction of surgical anaesthesia for caesarean operations in full-term pregnant women. They did not cause adverse effects on hemodynamic homeostasis and the neonates. KEY WORDS Spinal Anaesthesia, Local Anaesthetic, Fentanyl, Bupivacaine, Motor Block, Sensory Block.

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.