Mean Duration Of Analgesia Research Articles

Efficacy of dexmedetomidine as an adjuvant to ropivacaine in femoral nerve block for acute pain relief in patients with fracture of femoral shaft and neck

Background: The patients admitted to the emergency department with the fracture of femoral shaft and neck have severe pain, and these patients require adequate analgesia to allow radiological, orthopedic, and other procedures to be performed. Femoral nerve block (FNB) has proved to be effective in providing satisfactory analgesia. Dexmedetomidine has analgesic and sedative property when used as an adjuvant in regional anesthesia. The aim of this study was to evaluate the efficacy of dexmedetomidine added to ropivacaine in FNB with regard to onset, duration, efficacy of analgesia, and patient acceptance. Materials and Methods: Sixty patients of American Society of Anesthesiologists grade I and II of either sex, aged 18–60 years, who presented with the fracture of femoral shaft and neck in the emergency department were randomly divided into two groups of 30 patients each: group D (n = 30): patients were administered 15 mL ropivacaine (0.5%) plus dexmedetomidine 1 μg/kg body weight (total volume, 16 mL) and group R (n = 30): patients were administered 15 mL ropivacaine (0.5%) plus 1 mL saline. Results: The onset of analgesia was much earlier in group D (3.77 ± 0.84 min) than that in group R (4.6 ± 1.1 min). The mean duration of analgesia was prolonged in group D (744.33 ± 179.6 min) than that in group R (263 ± 67 min). The fall in visual analog scale score was significantly higher in group D in comparison to group R. The patient acceptance after 24 h of the procedure was better in group D. Conclusion: We concluded that the addition of dexmedetomidine to ropivacaine in FNB provides early onset of analgesia, prolongs the duration of analgesia, improves the quality of analgesia, and has better patient acceptance.

Effect of clonidine added to caudal ropivacaine in pediatric infraumbilical surgeries

Background: Caudal epidural block is the most popular regional anesthesia technique in pediatrics. Several agents are required as an adjuvant with a local anesthetic to prolong the duration of caudal analgesia by single shot technique in children. The aim of this study was to compare the efficacy of clonidine with ropivacaine versus ropivacaine alone for caudal analgesia in children undergoing infraumbilical surgeries under general anesthesia. Methods: Sixty patients of ASA grade I – II between the ages of 1-12 years, of either sex, undergoing infraumbilical surgeries under general anesthesia were included randomly into two groups: Control group (Group A) ropivacaine 0.2% (1ml/kg) with maximum volume 12 ml and clonidine group (Group B) ropivacaine 0.2% (1ml/kg) with clonidine 1μg/kg with maximum volume 12 ml. The changes of hemodynamic parameters were recorded intraoperatively. The FLACC pain score, sedation score, duration of analgesia and requirement of analgesic were recorded in the recovery room. Results: The demographic characteristic were comparable in both the groups. The mean duration of analgesia was significantly prolonged (707.3 ± 59.56 minutes) in group B compared to (411.83 ± 14.82 minutes) in group A. The requirement of first rescue analgesic medication was significantly prolonged in group B compared to group A (P < 0.05). Total analgesic consumption was significantly higher in group A (180 ± 70 mg) compared to group B (90 ± 70 mg) (P < 0.05) Conclusion: Addition of clonidine 1μg/kg to ropivacaine 0.2 % in caudal analgesia significantly increases the duration of postoperative analgesia compared to plain ropivacaine 0.2% without any significant sedation.

Comparison of intrathecal morphine and fentanyl in addition to ropivacaine for perioperative analgesia in lower segment caesarean section

Aim: To compare the analgesic efficacy of intrathecal morphine and fentanyl as an adjuvant to isobaric ropivacaine in patients undergoing lower segment caesarean section under spinal anesthesia. Materials and Methods: A total of 120 parturients aged between 20 and 35 years of age, belonging to American Society of Anaesthesiologist (ASA) physical status I and II, were randomized into two groups: Group M received 15 mg of 0.75% isobaric ropivacaine (2 mL) and 100 μg of morphine (1 mL) intrathecally; and Group F received 15 mg of 0.75% isobaric ropivacaine (2 mL) and 25 μg of fentanyl (0.5 mL) and 0.5 mL of normal saline intrathecally. The primary outcome was the duration of postoperative analgesia. Block characteristics, hemodynamic variables, demand for rescue analgesia, and adverse effects were also assessed. Results: The demographic profiles and block characteristics were comparable in all groups. The mean duration of analgesia in Group M and Group F was 996.03 ± 25.3 and 203.88 ± 25.20 min, respectively; the difference between the groups was highly significant (P < 0.0001). Lesser visual analog scale pain scores were observed in Group M after the fourth postoperative hour and continued till 24 h (P < 0.05 at time interval of 4, 6, 8, 12, and 24 h). Conclusion: The addition of intrathecal morphine to isobaric ropivacaine resulted in a longer duration of postoperative analgesia as compared to intrathecal fentanyl in parturients undergoing caesarean section under spinal anesthesia.

A study to compare caudal levobupivacaine, tramadol and a combination of both in paediatric inguinal hernia surgeries.

Background and Aims:Caudal block is a safe and simple method of pain relief in young children with the drawback of a short duration of analgesia which can be overcome by adding various adjuvants to the injected local anaesthetic. We compared the effects of caudal levobupivacaine, tramadol and a combination of both in paediatric patients undergoing inguinal herniotomy.Methods:A total of 78 children aged 1–7 years, planned for inguinal herniotomy were randomly allocated into three groups. Group L received levobupivacaine 0.125% 1 ml/kg, Group T received tramadol 1.5 mg/kg in 0.9% NS and Group LT 1 ml/kg of 0.125% levobupivacaine with 1.5 mg/kg tramadol caudally. The primary outcome was the duration of analgesia. Rescue analgesic doses required, the duration of motor blockade and adverse effects were recorded for 12 h post-operatively. Data was analysed by analysis of variance test, Kruskal-Wallis and Chi-square tests.Results:All groups were comparable with regard to age, sex and duration of surgery. No motor block was observed in any of the patients. The mean duration of analgesia in Group L was 321.46 ± 84.76 min, in Group T was 565.19 ± 107.08 min, and in Group LT was 720 min (P < 0.001). The requirement for rescue analgesia in tramadol group was significantly less as compared to levobupivacaine group. Sedation scores and adverse effects were comparable among all groups.Conclusion:Addition of tramadol to caudal levobupivacaine significantly increased the duration of postoperative analgesia.

A prospective randomised controlled study for evaluation of high-volume low-concentration intraperitoneal bupivacaine for post-laparoscopic cholecystectomy analgesia.

Background and Aims:Low-volume high-concentration bupivacaine irrigation of the peritoneal cavity has been reported to be ineffective for short-term analgesia after laparoscopic cholecystectomy (LC). This study was conducted to evaluate the effectiveness of intraperitoneal instillation of high-volume low-concentration bupivacaine for post-operative analgesia in LC.Methods:Sixty patients undergoing LC were included in this prospective, double-blind, randomised study. Patients were divided into two (n = 30) groups. In Group S, intraperitoneal irrigation was done with 500 ml of normal saline. In Group B, 20 ml of 0.5% (100 mg) bupivacaine was added to 480 ml of normal saline for intraperitoneal irrigation during and after surgery. Post-operative pain was assessed by numeric pain rating scale (NRS) at fixed time intervals. Duration of analgesia (DOA), total rescue analgesic requirement (intravenous tramadol), presence of shoulder pain, nausea and vomiting were recorded for the initial 24 h post-operatively.Results:Mean DOA in Group S was 0.06 ± 0.172 h (3.6 ± 10.32 min) and that in Group B was 19.35 ± 8.64 h (P = 0.000). Cumulative requirement of rescue analgesic in 24 h in Group S was 123.33 ± 43.01 mg and that in Group B was 23.33 ± 43.01 mg (P = 0.000). There was no significant difference in incidence of shoulder pain, nausea and vomiting between the groups.Conclusion:High-volume low-concentration of intraperitoneal bupivacaine significantly increases post-operative DOA and reduces opioid requirement after LC.

Pre-emptive Diclofenac Versus Ketoprofen as a Transdermal Drug Delivery System: How They Face.

To compare the analgesic efficacy of Diclofenac vis-a-vis Ketoprofen transdermal patch, in the management of immediate post-operative pain following orthognathic procedures. A prospective, double-blinded, randomised controlled study was conducted among 50 subjects, between 2012 and 2015. These patients were diagnosed clinically and cephalometrically as skeletal and dental class II malocclusion and underwent bi-jaw surgical procedure. In total, 25 Diclofenac and 25 Ketoprofen transdermal patches, sealed in envelopes and numbered, were administered to subjects. The patches used, contained 100mg of either Diclofenac or Ketoprofen and administered by a nurse prior to induction. Duration of analgesia, severity of pain using Visual Analog Scale, necessity of rescue analgesia (spontaneous pain>5 on a 10-cm scale) and any other adverse effect associated with the drug were evaluated. Mean duration of analgesia was significantly higher in the Ketoprofen group (20h), compared to Diclofenac group (13h) (p=0.001). Rescue analgesia was required in 12% of subjects who received Diclofenac patch, compared to 4% in Ketoprofen group. None of the subjects showed any allergic reactions. The study was designed to evaluate the efficacy of transdermal patch in reduction of post-operative pain in subjects undergoing bi-jaw surgeries. Subjects in both groups were comfortable and returned to early function. However, Ketoprofen transdermal patch had an edge over the Diclofenac transdermal patch with respect to analgesic efficacy.

The Effect of Dexmedetomidine Dosage on Duration of Spinal Anaesthesia using Hyperbaric Bupivacaine for Abdominal and Lower Extremity Surgeries

Spinal anaesthesia is commonly used for abdominal and lower limb surgeries. Dexmedetomidine, a new highly selective α2 agonist drug, is now being evaluated as a potential neuraxial adjuvant. This study has been designed to evaluate the addition of two doses of dexmedetomidine (10μg and 15μg) to 0.5% hyperbaric bupivacaine 3ml intrathecally for elective abdominal and lower limb surgeries. In a simple randomized study, 90 patients aged between 18-60 years of ASA I and II were randomized into three groups i.e., group I, II and III (n=30). All patients received a drug volume of 3.5 ml containing 3 ml hyperbaric bupivacaine (15 mg). They received dexmedetomidine 10μg (Group II) or 15μg (Group III) diluted to 0.5ml with 0.9% saline added to bupivacaine in the same syringe; the control group (Group I) received 0.5ml of 0.9% saline added to bupivacaine. It was found that the onset of sensory block upto T10 and motor block is statistically significantly faster in group II (155.17 sec and 203.83 sec) and III (99.37 sec and 170.13 sec) over group I (263.16 sec and 337.50 sec) in a dose dependent manner. The mean time for two segment regression, the mean time to sensory regression to S1, the mean duration of analgesia and the mean duration of motor blockade is significantly prolonged in Group III (141.67 min, 447.83 min, 400.67 min, 475.17 min) over Group II (106.17 min, 332.83 min, 287.67 min, 346.50 min) and Group II over Group I (97.33 min, 276.67 min, 243.17 min, 276.83 min) in a dose dependent manner (p<0.001). The data reveal that 15 μg of dexmedetomidine added to local anaesthetic in subarachnoid block to be a better adjuvant in prolonging the sensory and motor blockade intraoperatively and the duration of postoperative analgesia compared to 10 μg, without significant adverse effects. It is an attractive option for prolonged surgeries of the lower limb precluding the need for use of general anaesthetics and epidural anaesthesia.

Efficacy of tramadol as an adjuvant to bupivacaine for caudal analgesia in children: a randomised controlled trial

Background: The goal of postoperative analgesia is to minimise pain with least possible side effects and in our setting be as cost effective as possible. In children, caudal anaesthesia is typically combined with general anaesthesia for intraoperative and postoperative analgesia. Adjuvants can be added to local anaesthetics for prolonging the duration of analgesia. This study was done to find out the duration of analgesia of caudal Bupivacaine in combination with Tramadol.Methods: This prospective, randomised, double-blind, comparative study was done by taking a total of 60 patients, aged between 2 to 7 years undergoing elective lower abdominal, urological and lower extremity surgeries. The patients were randomized to group A (n=30) receiving 1 ml/kg of 0.25% bupivacaine and group B (n=30) receiving 1 ml/kg of 0.25% bupivacaine plus 1mg/kg of tramadol caudally. Duration of analgesia, hemodynamic responses and adverse effects were noted and analysed.Results: Thirty patients in both groups were comparable with regard to demographic data and hemodynamic response and were statistically non-significant (P&gt;0.05). It was observed that the mean duration of analgesia was significantly longer in group B (467.5±164.5 min versus 240.5±69.4 min, P&lt;0.001). One patient in each group had postoperative vomiting.Conclusion: Tramadol 1mg/kg as an adjuvant to bupivacaine 0.25% for caudal analgesia in children is effective in increasing the duration of analgesia without an increase of adverse effects.

Effect of Addition of Fentanyl and Clonidine to Local Anesthetic Solution in Peribulbar Block.

Objective:To compare the effect of addition of fentanyl and clonidine as adjuvants to bupivacaine and lignocaine in peribulbar block.Methods:The study was conducted on 105 adult patients of either sex, of ASA grade I and II undergoing ophthalmic surgeries. Patients were randomly divided into 3 groups of 35 each. All the patients were given peribulbuar block with 5ml lignocaine 2% +3 ml bupivacaine 0.5% +1 ml hyaluronidase (250 IU). In addition to this 1 ml normal saline was added to Group S, 25 μg fentanyl to Group F and 25 μg clonidine to Group C. Onset and duration of globe and lid akinesia, duration of sensory blockage and analgesia, hemodynamic parameters, number of rescue analgesic and visual analogue score were recorded.Results:The mean time of onset of globe and lid akinesia was significantly faster in group F and group C compared to group S, mean duration of globe and lid akinesia was longer in Group F (207.71 + 13.54 and 143.14 + 7.86 min) and group C (213.52 + 14.52 and 162.06 + 17.1 min) compared to group S (117.78 + 10.42 and 87.64 + 9.76 min). The mean duration of analgesia was significantly longer in group F (217.71 + 12.67) and C (258.82 + 14.50 min) as compared to group S (131.39 + 9.63 min).Conclusion:Addition of fentanyl or clonidine as adjuvant to local anaesthetic in peribulbar block provides faster onset and prolonged analgesia compared to local anaesthetic alone.

Effect of dexmedetomidine as an adjuvant to bupivacaine in femoral nerve block for perioperative analgesia in patients undergoing total knee replacement arthroplasty: A dose–response study

Context:Dexmedetomidine is being increasingly used in nerve blocks. However, there are only a few dose determination studies.Aims:To compare two doses of dexmedetomidine, in femoral nerve block, for postoperative analgesia after total knee arthroplasty (TKA).Settings and Design:A prospective, randomized, controlled trial was conducted in the Department of Anesthesia at AIIMS, a Tertiary Care Hospital.Materials and Methods:Sixty American Society of Anesthesiologists I–II patients undergoing TKA under subarachnoid block were randomized to three Groups A, B, and C. Control Group A received 20 ml (0.25%) of bupivacaine in femoral nerve block. Groups B and C received 1 and 2 μg/kg dexmedetomidine along with bupivacaine for the block, respectively. Outcomes measured were analgesic efficacy measured in terms of visual analog scale (VAS) score at rest and passive motion, duration of postoperative analgesia, and postoperative morphine consumption. Adverse effects of dexmedetomidine were also studied.Statistical Analysis Used:All qualitative data were analyzed using Chi-square test and VAS scores using Kruskal–Wallis test. Comparison of patient-controlled analgesia (PCA) morphine consumption and time to first use of PCA were done using ANOVA followed by Least Significant Difference test. A P < 0.05 was considered statistically significant.Results:The VAS score at rest was significantly lower in Group C compared to Groups A and B (P < 0.05). There was no difference in VAS score at motion between Groups B and C. The mean duration of analgesia was significantly longer in Group C (6.66 h) compared to Groups A (4.55 h) and B (5.70 h). Postoperative mean morphine consumption was significantly lower in Group C (22.85 mg) compared to Group A (32.15 mg) but was comparable to Group B (27.05 mg). There was no significant difference in adverse effects between the groups.Conclusion:The use of dexmedetomidine at 2 μg/kg dose in femoral nerve block is superior to 1 μg/kg for providing analgesia after TKA, although its role in facilitating early ambulation needs further evaluation.

Efficacy of Caudal Ketamine with Different Concentrations of Levobupivacaine for Postoperative Analgesia in Paediatric Subumblical Surgeries

Background: Caudal anaesthesia is the most popular regional anaesthetic technique used in the paediatric age group. Ketamine has been shown to have a synergistic effect with caudal local anaesthetics. Levobupivacaine is generally a well-tolerated anesthetic and analgesic with a wide range of clinical effectiveness and can be used as an alternative to bupivacaine. Methods: After approval from the hospital ethics committee and obtaining a parental informed written consent, fifty children with ASA score I and age ranges from 2-6 years randomized into 2 groups. Group I (n=25) received 0.75 ml/kg levobupivacaine 0.175% and preservative free s(+)-ketamine 0.5 mg/kg. Group II (n=25) received 0.75 ml/kg levobupivacaine 0.25% and preservative free s(+)-ketamine 0.5 mg/kg. Postoperative pain, duration of analgesia and time to first spontaneous leg movement between the two groups were compared. Results: There were no statistically significant differences between the two groups as regarding the mean duration of analgesia and pain score assessed by using the FLACC scale; P value of >0.05. Mean duration of motor block determined by the mean time to first spontaneous leg movement was significantly longer in group II when Compared to group I; P value of 0.000. Conclusion: The addition of ketamine decreased the required concentration of caudal levobupivacaine with a comparable duration of postoperative analgesia and significantly less residual motor blockade as compared to higher concentration.

Comparative Study of Clonidine with Ropivacaine versus Ropivacaine Alone in Epidural Anesthesia for Lower Limb Orthopedic Surgery.

Background:Epidural anesthesia has been well established as a safe and effective technique not only for perioperative anesthesia but also for postoperative analgesia. Various adjuvants have been added to local anesthetic agent in an effort to prolong this duration.Aims:The aim of this study was to compare and evaluate the anesthesia and analgesic property of ropivacaine to its combination with clonidine for lower limb orthopedic surgery under epidural.Materials and Methods:In a prospective, randomized, double-blind study, eighty adult patients undergoing lower limb surgeries received either 0.75% ropivacaine or 75 μg clonidine with 0.75% ropivacaine through epidural route. Patients were compared for hemodynamic variability, quality of motor and sensory block, intra- and post-operative analgesia, and the side effects associated.Statistical Analysis:Data analysis was done by Student's paired t-test, Chi-square test, and Mann–Whitney test. P < 0.05 was considered statistically significant.Results:The time taken for onset of the motor as well as the sensory block was significantly shorter in ropivacaine with clonidine group as compared to ropivacaine alone group. Mean duration of analgesia was significantly higher in patients who received clonidine as an adjunct (P < 0.001). There was no significant difference observed in the incidence of hemodynamic changes or side effects.Conclusion:The study demonstrated that use of clonidine as an adjuvant to ropivacaine through epidural route provides a hemodynamically stable, faster, and prolonged epidural block and a longer analgesic effect as compared to ropivacaine alone.

Comparison of Postoperative Pain After Epidural Anesthesia Using 0.5%, 0.75% Ropivacaine and 0.5% Bupivacaine in Patients Undergoing Lower Limb Surgery: A Double-Blind Study.

Background:Ropivacaine (S (-)-1-propyl-2”, 6”; pipecoloxylidide hydrochloride) a newer long-acting amide local anesthetic has various clinical and pharmacokinetic advantages over bupivacaine.Aims:The aim of this study is to compare the onset as well as the duration of sensory block, hemodynamic variables, and postoperative analgesia with 0.5%, 0.75% ropivacaine and 0.5% bupivacaine after epidural anesthesia for lower limb orthopedic surgery.Patients and Methods:Sixty American Society of Anesthesiologists I and II patients scheduled for lower limb orthopedic surgery were enrolled into this randomized, double-blind study. Epidural block was obtained with 15 ml of 0.5% ropivacaine (Group I), 15 ml of 0.75% ropivacaine (Group II), and 15 ml of 0.5% bupivacaine (Group III). The onset time, duration, and maximum level of sensory blockade achieved, as well as hemodynamic parameters and any side effects, were noted and treated accordingly. Postoperative monitoring for pain by visual analog scale (VAS) was done every 2 hourly for 24 h and transient neurological symptoms for 72 h.Statistical Analysis:Chi-square test for nonparametric data and ANOVA for parametric data.Results:Demographic characteristics were similar among groups. The onset of sensory block varied from 22.35 ± 2.74 min (mean ± standard deviation [SD]) in Group I, 16.95 ± 2.96 min (mean ± SD) in Group II, and 19.70 ± 2.25 min (mean ± SD) in Group III. The mean duration of analgesia in Group III (157 ± 14.90 min)was comparable to Group II (149 ± 16.51 min) but it was significantly more than Group I (141.5 ± 17.55 min). Postoperatively, VAS scores were higher in Group I patients who required more number of postoperative epidural top-ups with tramadol. Adverse effects were noted and treated accordingly. There was no incidence of transient neurological symptoms postoperatively.Conclusion:Both ropivacaine and bupivacaine provided effective epidural anesthesia for lower limb surgery. Postoperative pain was less with 0.5% bupivacaine and 0.75% ropivacaine as compared to 0.5% ropivacaine.

Buprenorphine as an adjuvant to 0.5% ropivacaine for ultrasound-guided supraclavicular brachial plexus block: A randomized, double-blind, prospective study

Context: Ultrasound-guided supraclavicular brachial plexus block is ideal for upper limb surgical procedures. Buprenorphine used as an adjuvant to ropivacaine may prolong analgesia. Aims: The aim is to assess the analgesic efficacy and safety of buprenorphine added to 0.5% ropivacaine solution. Settings and Design: This prospective, double-blind, randomized study was conducted on 60 adult patients of the American Society of Anesthesiologists physical Status I and II undergoing various upper limb surgeries under ultrasound-guided supraclavicular brachial plexus block. Subjects and Methods: Patients were allocated into two groups of 30 each to receive either 30 ml 0.5% ropivacaine with 1 ml buprenorphine (0.3 mg) (Group B) or 30 ml 0.5% ropivacaine with 1 ml normal saline (Group C) for supraclavicular brachial plexus block. Onset, duration, and quality of sensory block and motor block; duration of analgesia and side effects were observed. Results: The mean duration of analgesia was significantly longer in Group B (868.2 ± 77.78 min) than in Group C (439.3 ± 51.19 min). The mean duration of motor and sensory block were significantly longer in Group B (451.8 ± 57.18 min) and (525.8 ± 50 min), respectively, than in Group C (320.5 ± 43.62 min) and (373 ± 53.78 min), respectively (P < 0.05). Conclusions: Addition of buprenorphine to ropivacaine for ultrasound-guided supraclavicular brachial plexus block prolonged the duration of sensory and motor blockade and postoperative analgesia without an increase in side effects.

Intravenous Dexmedetomidine enhances the Duration of Spinal Anesthesia with 0.5% Hyperbaric Bupivacaine in Lower Abdominal Surgeries

ABSTRACT Introduction Spinal block is a preferred technique for most lower abdominal and lower limb surgeries. Lignocaine had been the local anesthetic of choice for decades in such surgeries. With the advent of adjuvants, now it has become possible to enhance the duration of spinal anesthesia. These adjuvants can be given intravenously or intrathecally. Intravenous clonidine and dexmedetomidine have been used in recent studies as adjuvant in spinal anesthesia with promising results. Dexmedetomidine is a more suitable adjuvant compared with clonidine due to its more selective alpha-2A receptor agonist activity. Aims and objectives To evaluate the effect of intravenous dexmedetomidine on spinal anesthesia with 0.5% bupivacaine in lower abdominal surgeries in terms of onset and duration of sensory and motor blockade and sensory regression. Materials and methods Sixty patients of American Society of Anesthesiologists grades I and II, 25 to 60 years of age, posted for elective lower abdominal surgeries under spinal anesthesia were included in the study and randomly allocated into computer-generated two groups. Group IV received intrathecal 0.5% bupivacaine heavy and intravenous infusion of dexmedetomidine 1 μg/kg over 20 minutes followed by 0.5 μg/kg/hour till the end of surgery. Patients in group III (control group) received intrathecal 0.5% bupivacaine heavy and intravenous normal saline as placebo. Results In groups IV and III, mean duration of analgesia was 209 ± 29.93 and 150.20 ± 3.46 minutes respectively. This increase in duration of analgesia in dexmedetomidine group was statistically significant. The mean duration of motor blockade was 189.48 ± 1.34 and 158.18 ± 3.27 minutes respectively. Injection diclofenac sodium 75 mg intramuscularly was used as rescue analgesic. How to cite this article Sharma YK, Agrawal M. Intravenous Dexmedetomidine enhances the Duration of Spinal Anesthesia with 0.5% Hyperbaric Bupivacaine in Lower Abdominal Surgeries. Int J Adv Integ Med Sci 2017;2(3):144-148.

Analgesic Effect of Intra-articular Morphine or Dexmedetomidine Added with Levobupivacaine in Arthroscopic Knee Surgeries - A Comparative Evaluation.

Knee arthroscopy is associated with variable amount of postoperative pain. In an attempt to improve postoperative analgesia, intra-articular injection of local anaesthetic in combination with other agent have been studied. However, the best combination is not known. To compare the analgesic efficacy of intra-articular injection of morphine and dexmedetomidine when added with levobupivacaine in arthroscopic knee surgeries. Seventy eight patients, scheduled to undergo elective arthroscopic procedure under spinal anaesthesia were recruited for the study. All the patients received 18 ml of 0.25% levobupivacaine however in addition to this Group M patients received 8 mg (2 ml) morphine, Group D patients received 100μg (2 ml) of dexmedetomidine while Group C patients received 2 ml of isotonic saline intra-articularly. Postoperatively the intensity of pain was assessed using Numerical Rating Scale (NRS). Rescue analgesia was given at NRS ≥ 4. The duration of analgesia and total diclofenac consumption was noted. The mean duration of analgesia was longest in Group M (576.20±67.09 minutes) followed by Group D (460.93±38.95 minutes) and Group C (370.27±58.80 minutes) statistically this difference was found to be highly significant (p-value < 0.001). Total consumption of diclofenac in 24 hours was found lowest in group M (86.25±27.48 mg) followed by group D (110.87±44.48 mg) and group C (141.35±44.13 mg) this difference was found to be highly significant (p-value < 0.001). Morphine when added with levobupivacaine in patients undergoing arthroscopic knee surgery improves the quality and prolongs the duration of postoperative analgesia.

Comparison of Analgesic Efficacy of Dexmedetomidine and Midazolam as Adjuncts to Lignocaine for Intravenous Regional Anesthesia.

Background:Intravenous regional anesthesia (IVRA) is safe, technically simple, and cost-effective technique compared to general anesthesia with success rates of 94–98% for upper and lower limb surgeries. The main disadvantage of this procedure is its limited duration for surgery, lack of postoperative analgesia, and tourniquet pain. To overcome this disadvantage, various adjuvants to lignocaine have been studied from time to time.Aim:To compare the analgesic efficacy of dexmedetomidine and midazolam as adjuncts to lignocaine for IVRA for forearm and hand surgeries.Setting and Design:The study was conducted by the Department of Anaesthesia of Medical College and patients posted for elective as well as the emergency forearm and hand surgeries were included in the study. It was a prospective comparative study.Materials and Methods:Sixty patients of either sex belonging to the American Society of Anesthesiologists Class I and II, in the age range of 18–65 years, scheduled for upper limb orthopedic surgery, either elective or emergency, were included in the study. All patients were administered IVRA in this prospective, double-blind, randomized study. Patients enrolled in the study were randomly divided into two groups of thirty each. Group M-received 40 ml of 0.5% lignocaine with midazolam 50 μg/kg and Group D-received 40 ml of 0.5% lignocaine with dexmedetomidine 1 μg/kg. Time of onset of sensory block, duration of analgesia, total dose of fentanyl given, intraoperative blood pressure, oxygen saturation, heart rate, postoperative analgesia, and adverse effects were recorded and compared between the groups.Statistical Analysis Used:The statistical evaluation was performed using SPSS version 17.0 software. All values were calculated with a 95% confidence interval. The parameters were expressed as mean ± standard deviation and t-test was used for comparing demographic and clinical data. For comparisons, P < 0.05 was considered statistically significant.Results:Mean duration of analgesia was 93 ± 28 min in dexmedetomidine group and 84 ± 28 min in midazolam group, and onset of sensory block was comparable in both groups.Conclusion:Dexmedetomidine and midazolam, when used as adjuvants to lignocaine for IVRA, significantly improve the intraoperative conditions by providing superior quality of block. The superiority of one over the other could not be established as midazolam produced the early onset of block and less requirement of fentanyl, whereas dexmedetomidine when added to IVRA provided longer duration of analgesia (93 ± 28 min) in comparison to midazolam (84 ± 28 min).

Comparative study of caudal clonidine and midazolam added to bupivacaine during infra-umbilical surgeries in children.

Background and Aims:Caudal analgesia is a good, reliable, and easy method to provide intraoperative and postoperative analgesia for infra-umbilical surgeries in children. Many additives are being used in combination with local anesthetics in caudal block to prolong the postoperative analgesia (clonidine, midazolam, ketamine, fentanyl, and dexmedetomidine). The purpose of this study was to compare the intraoperative hemodynamics, postoperative analgesia, postoperative rescue analgesic requirement, postoperative sedation and side-effects of clonidine and midazolam used as adjuvants to bupivacaine for caudal analgesia.Material and Methods:Following approval from Institutional Ethical Research Committee, 75 American Society of Anesthesiologists I and II patients aged between 1 and 7 years undergoing various elective infra-umbilical surgical procedures were included in this study. The patients were randomly allocated into three groups of 25 patients each. Group B received 1 ml/kg 0.25% bupivacaine in normal saline, Group BC received 1 ml/kg 0.25% bupivacaine + 1 μg/kg clonidine in normal saline, and Group BM received 1ml/kg 0.25% bupivacaine + 30 μg/kg midazolam in normal saline. The various parameters studied were intraoperative hemodynamic changes, duration of postoperative analgesia, postoperative sedation, postoperative analgesic requirement, and incidence of side-effects.Results:All the groups were similar with respect to patient and block characteristics. The hemodynamic parameters before and after administering caudal analgesia were also comparable. The mean duration of analgesia was 724.80 ± 60.29 min in Group BC, 605.40 ± 82.37 min in Group BM and 295.00 ± 41.78 min in Group B. Thus, the duration of analgesia was significantly prolonged in Group BC compared to Groups BM and B. The FLACC pain score was higher in Group B at the end of 4th, 8th and 12th h compared with Group BC and Group BM. Furthermore at the end of 12th h, pain scores were significantly higher in Group BM compared to Group BC. Only 1 child in Group BC received three rescue medications compared to 15 (60%) children in Group B and 7 (28%) children in Group BM. None of the groups were treated for bradycardia or hypotension and no significant sedation was noted.Conclusion:This study showed that the addition of both clonidine (1 μg/kg) and midazolam (30 μg/kg) with bupivacaine administered caudally significantly increase the duration of postoperative analgesia with minimal side-effects in children. The use of clonidine as an additive to bupivacaine in caudal epidural is a superior choice to midazolam as it reduces the demand of postoperative rescue analgesics significantly.

Analgesic efficacy of dexamethasone as an adjuvant to caudal bupivacaine for infraumbilical surgeries in children: A prospective, randomized study.

Background and Aims:Provision of adequate perioperative analgesia in children is important to attenuate the stress response to surgery. Caudal analgesia using local anesthetics is a traditionally used technique but provides a limited duration of analgesia. Several adjuvants can be added to local anesthetics to increase the duration of action. This study was undertaken to evaluate the efficacy of dexamethasone added to bupivacaine for caudal block in children.Material and Methods:This was a prospective, double-blinded trial on 130 children aged between 6 months and 6 years of age allocated randomly into one of two groups for elective subumbilical surgeries. Children in Group C received caudal bupivacaine and those in Group D received caudal bupivacaine with 0.1 mg/kg of dexamethasone.Results:The mean duration of analgesia when dexamethasone was added to caudal bupivacaine was 1044.92 (±48.66) min, while it was 435.85 (±17.95) min with plain bupivacaine. The number of doses of rescue analgesics required and the mean pain score was also lesser in this group.Conclusion:The addition of 0.1 mg/kg of dexamethasone to caudal bupivacaine increases the duration of analgesia of caudal bupivacaine without any side effects in children undergoing subumbilical surgeries.

Comparison of analgesic efficacy of caudal dexmedetomidine versus caudal tramadol with ropivacaine in paediatric infraumbilical surgeries: A prospective, randomised, double-blinded clinical study.

Background and Aims:Caudal epidural analgesia is commonly practised regional block technique in children undergoing infraumbilical surgeries but has a short duration of action after single shot local anaesthetic injection. The aim of this study was to compare ropivacaine 0.25% with dexmedetomidine and tramadol in caudal anaesthesia in paediatric infraumbilical surgeries.Methods:In a randomised, prospective, double-blinded study, sixty children (1–8 years) belonging to American Society of Anesthesiologists’ physical status I or II scheduled for infraumbilical surgeries were included. They were randomly assigned into two groups: Group ropivacaine with tramadol (RT) (n = 30) received 0.25% ropivacaine 1 mL/kg with 2 mg/kg of tramadol, and Group ropivacaine with dexmedetomidine (RD) (n = 30) received 0.25% ropivacaine 1 mL/kg with dexmedetomidine 2 μg/kg. The primary outcome variable was the duration of analgesia, and the secondary outcome variables included motor block, sedation score, time from caudal block to skin incision, emergence time and adverse effects.Results:The mean duration of analgesia was 654.20 ± 78.38 min in Group RT, while in Group RD, it was 780.29 ± 71.21 min (P = 0.0001). The difference between the mean sedation score and mean emergence time between the two groups were statistically significant (P = 0.0001 and 0.0411, respectively). No significant difference was observed in the incidence of haemodynamic changes or side effects.Conclusion:Caudal dexmedetomidine with ropivacaine prolongs post-operative analgesia compared to caudal tramadol with ropivacaine.