Mean Duration Of Block Research Articles

A comparative study of plain and hyperbaric solutions of 0.75% ropivacaine in spinal anaesthesia in elective lower abdominal and lower limb surgeries

Background and objective: Spinal anaesthesia is the most common technique of regional anaesthesia used for lower abdominal and lower limb surgeries. Bupivacaine is the commonly administered drug. Ropivacaine, is an amino amide local anaesthetic, which has less cardiovascular and central nervous systems toxicity compared with bupivacaine. This study is undertaken to compare plain and hyperbaric solutions of ropivacaine in spinal anaesthesia. Methods: 80 patients of ASA I/II physical status undergoing elective lower abdominal and lower limb surgeries were randomised into 2 groups. Group C (n=40) patients received 3ml of 0.75% plain ropivacaine with 0.4 ml of normal saline and Group D (n=40) patients received 3 ml of 0.75% plain ropivacaine with 0.4 ml of 25% dextrose. Hemodynamic parameters, time of onset and duration of sensory and motor blockade, maximum height of block, total duration of sensory and motor blockade and time to mobilise were recorded. Results: Hemodynamic parameters were comparable between the two groups except at few intervals. Demographic data and duration of surgery were comparable. The onset of block to T10 in group C 10.1 ± 1.6 min, group D 4.6 ± 0.9 (p value <0.001), mean time to maximum block in group C 13.0 ± 2.7 min, group D 8.9 ± 0.9 (p value <0.001) were statistically significant. Mean duration of block at T10 in group C was 94.7± 24.7 min, group D 146.1 ± 31.9 (p value <0.001), duration of sensory regression in group C 291.6 ± 74.3 min, group D 239.9 ± 39.8 (p value <0.001), duration of motor regression in group C 225.4 ± 68.4 min, group D 186.0 ± 41.0 (p value 0.003) and time to mobilise in group C was 309.1 ± 76.3 min, group D 251.0 ± 41.1 min (p value <0.001) which were statistically significant. Conclusion: Hyperbaric ropivacaine has early and faster onset, spreads more to higher levels, has more denser block and is early to regress compared to plain ropivacaine.

Safety and efficacy of adding different doses of neostigmine as an adjuvant in peribulbar block for cataract surgery: A randomized controlled trial

ABSTRACT Background: This study aimed to evaluate safety and efficacy of adding two different doses of neostigmine to the local anesthetic lidocaine in peribulbar block anesthesia for cataract surgery. Methods: This randomized, double blind, parallel group, controlled trial (Trial registration number: IRCT20210106049952N1) included 60 patients (30–70 years-old), ASA physical status I, II, or III who were scheduled for cataract surgery. Patients received standard peribulbar block (Group C) or standard block plus 0.25 mg neostigmine (Group N25) or 0.5 mg neostigmine (Group N50). All patients were assessed for primary outcomes including hemodynamics and onsets of motor and sensory blocks. Secondary outcomes included duration of block, patient’s and surgeon’s satisfaction, postoperative pain, and time to first analgesic dose. Results: Mean onset of motor block was significantly shorter in N25 and N50 groups (72.25 ± 20.3 and 44.3 ± 10.4 sec, respectively) than in control group (110.25 ± 35.6 sec). Onset of sensory block was significantly shorter in N50 group compared to control group as well as N25 group (P < 0.001). A significantly longer mean duration of block was observed in N50 group (173.55 ± 31.09 min) in comparison to control group (79.75 ± 12.51 min) and N25 group (81.25 ± 6.25 min). Mean time till first analgesic dose showed significant differences between the three groups C, N25, and N50 (2.85 ± 0.47, 3.45 ± 1.28, and 7.1 ± 1.25 h, respectively, P < 0.001). Only two patients belonging to N50 group developed postoperative nausea and vomiting. Conclusion: Neostigmine in 0.5 mg was superior to 0.25 mg dose when added to the local anesthetic lidocaine in peribulbar anesthesia for cataract surgery regarding both sensory and motor block as well as postoperative analgesia.

Comparing anaesthetic effects of intrathecal 2- Chloroprocaine with or without fentanyl in ambulatory surgeries- A prospective and randomized control study

1% 2-Chloroprocaine could have been an ideal local anaesthetic for ambulatory procedures but it has been neglected in past years and even after re introduction with its preservative and antioxidant free form. To compare the anaesthetic effect of intrathecal 2-Chloroprocaine with or without fentanyl in patients undergoing short duration lower abdominal and lower limb surgeries regarding hemodynamic parameters, mean duration of block, time to ambulation and side effects.Anesthesia Department at Narayana Multispeciality Hospital, Jaipur.Randomised, Comparative, Single Centre StudyA total of 120 patients,18-70 years, weight&amp;#62;50 kg and ASA grade I- II underwent elective lower abdominal and lower limb surgeries with expected duration &amp;#60;60 minutes were randomly allocated in two groups of 60 each to receive either 40mg 2- Chloroprocaine with saline or 25 µg fentanyl. Chi-Square and Unpaired Student T- Test (p&amp;#60;0.05). Spinal anesthesia was successful for all patients. Onset time of sensory and motor block, time to achieve peak block height and complete motor block was statistically insignificant (p&amp;#60;0.05). Time to complete sensory recovery was 105.87mins in fentanyl group and 69.17mins in saline group and time to compete motor recovery 80.13 mins in fentanyl group and 64.80 mins in saline group (p&amp;#60;0.001). Transient neurological symptoms were not found. 2-Chloroprocaine spinal anesthesia provides rapid onset, giving it a promising profile for ambulatory surgery. Addition of fentanyl lengthens regression to S2 and with minimal increase of motor block duration.

Evaluation of quality of recovery score in mothers and neonatal outcome assessment after surgery using preoperative dexamethasone for caesarean section

BackgroundQuality of recovery (QoR) after surgery is an essential measure of early postoperative health status of the patient. The incidence of caesarean section (CS) has increased in the last few decades. Numerous studies have been conducted for reduction of pain after CS but only a few on the effect of preoperative dexamethasone on QoR after CS. This study is designed to evaluate QoR with dexamethasone and neonate outcome assessment after CS. MethodsThis is a prospective, randomised study in which patients undergo CS under spinal anaesthesia (SA). Patients received either 8 mg (2 ml) of dexamethasone IV (group D, n = 30) or 2 ml of 0.9% normal saline (group C; n = 30) before SA. The QoR-40 and Apgar score, neonatal respiratory distress, haemodynamic response and ill effects were recorded. ResultsThe baseline haemodynamic (heart rate, mean arterial pressure (MRP), Respiratory rate (RR) and pulse oximetry) parameters were comparable in both the groups. The mean global score and each score in group D was better than that of group C (p < 0.001). The mean duration of block in group D (169.83 ± 9.05 min) was more than that in group C (163.33 ± 11.91 min) (p < 0.021). The incidence of neonatal respiratory distress, neonatal intensive care unit admission and Apgar score at 1 min and at 5 min of birth was comparable between the groups. ConclusionDexamethasone has a positive effect on early postoperative recovery of patients undergoing CS with a delay in regression of spinal block and without any significant adverse effects on neonatal outcomes.

Predicting postoperative pain with neutrophil/ lymphocyte ratio after arthroscopic rotator cuff repair

BackgroundPostoperative pain is well known and usually disturbing complication of arthroscopic shoulder surgery. Inflammation plays an important role in the development and progression of postoperative pain. The aim of this study was to evaluate the predictability of postoperative pain through the correlation of neutrophil/lymphocyte ratio (NLR) with inflammation. In addition, the correlation of parameters such as operative time, tear size, age and gender with postoperative pain was evaluated. MethodsSixty three patients, who underwent arthroscopic rotator cuff repair, were evaluated in this single-center-based retrospective study. The American Society of Anaesthesiologists I and II risk groups were determined as the inclusion criteria. NLR was calculated using preoperative one day hemogram values in all patients. The amounts of analgesic use and Numerical Rating Scale (NRS) scores at the 12th, 24th and 48th hours and on the 3rd and 7th days were recorded. Multivariate linear regression analysis was used to correlate postoperative NRS scores with multiple independent factors, including preoperative NLR, sex, age, tear size, repair type, operative time, block time, postoperative analgesic intake and length of hospital stay. ResultsSixty three patients with a mean age of 59.4 years (range, 40–72 years) were evaluated. The mean tear size was 2.8 cm (range, 1–5 cm), the mean operative time was 84.1 min (range, 35–135 min), the mean duration of block was 7.6 hours (range, 4–12 hours) and the mean length of hospital stay was 1.7 days (range, 1–3 days). There was no significant correlation between age, sex, tear size, repair type, operative time and postoperative NRS (p > 0.2). The preoperative NLR was found to be a strong predictor of postoperative NRS (p < 0.001, rho = 0,864). There was a correlation between the NLR and mean analgesic intake (p = 0,03). The duration of block was decreased in patients with a NLR above 2, while it was prolonged in patients with a NLR below 2 (p = 0.04, rho = −0,725). ConclusionThe preoperative NLR was found to be a strongest factor predicting high acute pain levels after arthroscopic rotator cuff surgery. Likewise, NLR was also predictive of postoperative block time and analgesic consumption.

English

Paravertebral nerve block (PVB) is an anesthetic technique that results in less postoperative pain; nausea and vomiting require fewer analgesics. The aim of our study was to compare the postoperative analgesia provided by multilevel thoracic paravertebral injections of bupivacaine (0.5%) and ropivacaine (0.5%) in patients undergoing unilateral breast surgery. MATERIALS AND METHODS: It was a comparative randomized double blind study. Sample size was calculated at 80% study power and α error 0.05 came out to be 25 patients in each group which was further enhanced to 30 patients. Data were analyzed using SPSS version 12. Student's T-test and Chi- square test were applied.60 ASA, I/ II patients, aged 18-56 years, body weight 50-80kg scheduled for unilateral breast surgery were randomly chosen to receive PVB from T2-T5 with either bupivacaine 0.5% (group1) or ropivacaine 0.5% (group 2) 5ml at each level. Variables of efficacy were the amount of fentanyl consumption, postoperative pain on visual analogue pain score (VAS) upto 24 hours. Post-operative nausea and vomiting, any other complication, duration of block and both surgeon and patient's satisfaction score. RESULTS AND OBSERVATION: Time to rescue analgesic was 302.87±75.07 I group 1 and 299.89±86.67 in group 2 and was statistically insignificant( P >0.05)However, mean duration of block was 21.21±5.521 hrs and 22.63±3.874hrs in group 1 and in group 2 which was comparable.(P value >0.05) . Seven patients in group 1 and four patients in group 2 required fentanyl as rescue analgesic. Frequency (times/patient) was 8(0.24±.50) and 6(0.17±.51) in group 1 and 2 respectively. Total dose of fentanyl in mg/kg/patient was 0.12±0.25 and 0.09±0.26 in group 1 and group 2 and is statistically insignificant. (P value >0.05). VAS score in the immediate post operative period was 1.12±0.48 and 1.00±.65 in group 1 and group 2.(P > 0.05)VAS score at 4hr, 8hr, 12hr and at 24 hr remained statistically insignificant. None of the patients in the PVB group had any complication in the first 24-hour in postoperative period. No statistical significances in postoperative nausea (P = 0.274), surgeon and patient's satisfaction score between the groups. CONCLUSION: Both drugs are equally effective in providing postoperative analgesia after breast

Prolonged intercostal nerve blockade in sheep using controlled-release of bupivacaine and dexamethasone from polymer microspheres.

Previous work from the authors' group characterized a prolonged percutaneous blockade of the sciatic nerve in rats using bupivacaine-dexamethasone microspheres. The goals of the current study are to examine the (1) efficacy of bupivacaine microspheres with and without dexamethasone for intercostal blockade in sheep; (2) scaling of dose and duration with a 100-fold increase in body size from rats to sheep; (3) local toxicity and adverse systemic reactions to bupivacaine microspheres with and without dexamethasone. Intercostal blocks were performed percutaneously in sedated sheep. Sensory blockade was measured at repeated time points by absent flinch response to skin pinch. Plasma bupivacaine concentrations were measured using high performance liquid chromatography. Chest wall specimens were examined by light microscopy. The duration of intercostal blockade increased with bupivacaine dose for animals receiving from 8 to 80 mg/kg of microspheres with and without dexamethasone. At each dose, microspheres containing dexamethasone had a longer duration of block than microspheres without dexamethasone. From 8 to 80 mg/kg, the mean duration of block with bupivacaine-dexamethasone microspheres increased from 4 to 13 days. Plasma concentrations of bupivacaine remained 10-fold below the convulsive EC50 concentration for sheep. Chest wall histology showed a significant granulomatous reaction around bupivacaine microspheres but not around bupivacaine-dexamethasone microspheres. A single administration of bupivacaine-dexamethasone microspheres produces an effective chest wall analgesia of several days' duration. This may prove useful clinically for thoracic surgery or trauma.

The Local Anesthetic Activity of Tetrodotoxin Alone and in Combination With Vasoconstrictors and Local Anesthetics

Tetrodotoxin (TTX), alone and in combination with various vasoconstrictors and local anesthetics, was evaluated for its ability to produce peripheral nerve blocks in the rat and central neural blocks in the cat and dog. High frequency and long duration of block can be attained if sufficiently high concentrations of TTX are used, although latency is long and high dosage may produce systemic toxicity. Frequency and mean duration of block can be increased and systemic toxicity reduced if TTX is administered with a vasoconstrictive agent. Conventional local anesthetics also enhance the nerve-blocking activity of TTX. When appropriate concentrations of TTX and local anesthetics are used, a high frequency of blocks characterized by short latency and long duration can be demonstrated. The studies present some indirect evidence that local anesthetics enhance TTX activity by reversibly increasing the permeability of various neural barriers to TTX.

MATERNAL AND FOETAL PLASMA CONCENTRATIONS OF BUPIVACAINE AFTER EPIDURAL BLOCK

Plasma bupivacaine concentrations were measured in 70 mothers and babies (UV) at delivery, after continuous epidural block using bupivacaine 0.5% alone in half the cases and bupivacaine 0.5% with adrenaline (5 μg/ml) in the remainder. Patients received a total dose of 40–500 mg of bupivacaine in 1–10 doses. The mean individual dose was about 47 mg and the mean duration of block 6 hours in both groups. The mean maternal plasma concentration was 0.54±0.05 μg/ml (SE) after bupivacaine alone and 0.36±0.03 μg/ml after bupivacaine with adrenaline. This difference is significant (P

MATERNAL AND FOETAL PLASMA CONCENTRATIONS OF BUPIVACAINE AFTER EPIDURAL BLOCK

Plasma bupivacaine concentrations were measured in 70 mothers and babies (UV) at delivery, after continuous epidural block using bupivacaine 0.5% alone in half the cases and bupivacaine 0.5% with adrenaline (5 μg/ml) in the remainder. Patients received a total dose of 40–500 mg of bupivacaine in 1–10 doses. The mean individual dose was about 47 mg and the mean duration of block 6 hours in both groups. The mean maternal plasma concentration was 0.54±0.05 μg/ml (SE) after bupivacaine alone and 0.36±0.03 μg/ml after bupivacaine with adrenaline. This difference is significant (P

MATERNAL AND FOETAL PLASMA CONCENTRATIONS OF BUPIVACAINE AFTER EPIDURAL BLOCK

Plasma bupivacaine concentrations were measured in 70 mothers and babies (UV) at delivery, after continuous epidural block using bupivacaine 0.5% alone in half the cases and bupivacaine 0.5% with adrenaline (5 μg/ml) in the remainder. Patients received a total dose of 40–500 mg of bupivacaine in 1–10 doses. The mean individual dose was about 47 mg and the mean duration of block 6 hours in both groups. The mean maternal plasma concentration was 0.54±0.05 μg/ml (SE) after bupivacaine alone and 0.36±0.03 μg/ml after bupivacaine with adrenaline. This difference is significant (P