Mean Duration Of Sensory Block Research Articles

Effects Of Low Doses Of Intrathecal Clonidine And Dexmedetomidine With Bupivacaine On The Duration Of Sensory And Motor Block In Abdominal And Lower Limb Surgeries- A Prospective Randomised Double Blinded Study

BACKGROUND: The purpose of this study is to compare the duration of sensory and motor block in elective lower limb and abdominal procedures following intrathecal administration of bupivacaine along with adjuvants either clonidine or dexmedetomidine. METHODS: A prospective randomised double blinded study. 120 study participants were randomly allocated to three groups-Group A was given 12.5 mg of hyperbaric bupivacaine, Group B was given 3 mcg dexmedetomidine along with 12.5 mg hyperbaric bupivacaine and Group C was given 30 mcg of clonidine along with hyperbaric bupivacaine. The duration of sensory and motor block was recorded. RESULTS: Group B and C study participants showed significantly longer duration of sensory and motor block when compared to Group A. The mean duration of sensory block in Group A was 92.5 minutes, Group B 124.5 minutes Group C (119.4 minutes) (A vs B, A vs C p<0.001). The mean duration of motor block in group A 149.1 min, group B 252.5 min, Group C 217 min (A vs B, A vs C, B vs C P<0.001) CONCLUSION: By adding 3 mcg dexmedetomidine or 30 mcg clonidine to hyperbaric bupivacaine duration of sensory and motor block was significantly prolonged.

Effectiveness of Ultrasound-guided Adductor Canal Block for Postoperative Pain Management in below Knee Orthopaedic Surgeries: A Randomised Controlled Study

Introduction: The sensory innervation below the knee is provided by the saphenous nerve and sciatic nerve. Drugs deposited in the Adductor Canal (AC) at the Adductor Hiatus (AH) level spread both proximally up to the mid-canal and distally to the popliteal fossa through the perivascular space. The Adductor Canal Block (ACB) is a newer technique by which both nerves can be blocked in a single procedure. Aim: To evaluate the efficacy of ACB for postoperative pain management in below knee surgeries. Materials and Methods: This randomised controlled study was conducted in a tertiary care hospital. A total of 81 patients with American Society of Anaesthesiologists (ASA) I and II physical status were randomly allocated to either group A (ACB) or group B (Control), scheduled for below knee orthopaedic surgery. Group A patients received a mixture of 40 mL of 0.125% bupivacaine and 8 mg dexamethasone in the AC at the hiatus level under ultrasound guidance. Group B patients received standard care for pain management. The duration of sensory and motor block, mean Visual Analogue Scale (VAS) scores, amount of opioid drug requirement, drug-related side-effects, and satisfaction scores were compared between the two groups. Data were presented as mean±Standard Deviation (SD) for continuous variables and frequency (%) for categorical data and were analysed using t-tests and Chi-square tests. Results: The mean age in group A was 42.9±13.5 years and in group B was 46.3±13.1 years. In group A, there were 30 males and 11 females, while in group B, there were 32 males and 8 females. The mean Body Mass Index (BMI) between group A and B was 27.4±3.2 kg/m2 and 26.3±3.1 kg/m2 , respectively. The mean duration of sensory block was longer in group A (12.3±4.6 hours) compared to group B (4.7±0.7 hours). The mean VAS scores (1.351±0.659 vs 3.240±0.590) were significantly lower in group A. The total opioid requirement was 42.9±73.6 mg vs 205.9±26.0 mg between the two groups, which was significantly lower in group A. Conclusion: In distal ACB, a single procedure with 40 mL of 0.125% bupivacaine significantly reduces postoperative VAS scores and analgesic requirements while increasing patient satisfaction levels. Therefore, this block is safe and recommended for postoperative pain management in below knee surgeries.

Effects of dexmedetomidine, fentanyl and magnesium sulfate added to ropivacaine on sensory and motor blocks in lower abdominal surgery: a randomized clinical trial

This study aimed to compare the effects of intrathecal dexmedetomidine, fentanyl and magnesium sulfate added to ropivacaine on the onset and duration of sensory and motor blocks in lower abdominal surgery. This double-blind randomized clinical trial included 90 patients scheduled for lower abdominal surgery at Vali-Asr Hospital in Arak, Iran. The enrolled patients were randomly divided into three equal groups and then underwent spinal anesthesia. The first group received 10 μg of dexmedetomidine, the second group received 50 μg of fentanyl, and the third group received 200 mg of 20% magnesium sulfate intrathecally in addition to 15 mg of 0.5% ropivacaine. In the dexmedetomidine group, the mean arterial blood pressure was lower than the other two groups (P = 0.001). Moreover, the time to onset of sensory block (P = 0.001) and the mean duration of sensory block (P = 0.001) were shorter and longer, respectively, in the dexmedetomidine group than in the other two groups. In the dexmedetomidine group, the mean time to onset of motor block (P = 0.001) and the mean duration of motor block (P = 0.001) were lower and higher than in the other two groups, respectively. There was no significant difference in visual analog scale score, heart rate, administered opioid, and drug side effects among the three groups. Dexmedetomidine caused early sensory and motor blocks while prolonging the duration of sensory and motor blocks compared with the other two groups. In addition, dexmedetomidine reduced mean arterial blood pressure in patients. Based on the findings of this study, it is recommended that dexmedetomidine can be used in order to enhance the quality of sensory and motor block in patients.

Comparison of Dexmedetomidine and Dexamethasone as an Adjuvant to Bupivacaine in Onset and Interval of Supraclavicular Nerve Block

Aim: To compare duration and onset of motor and sensory block by using dexmedetomidine and dexamethasone as adjuvant to bupivicaine in supraclavicular brachial plexusblock. Place and duration of study: Department of Anaesthesiology, Surgical Intensive Care & Pain Management, Civil Hospital, Dow University of Health Sciences Karachi from 29th June 2022 to 29th December 2022. Design: Randomized controlled trial study Methodology: Sixty patientswere enrolled in the study that had an elective upper-limb surgery performed under supraclavicular anesthesia of hand, wrist, forearmand elbow were allocated through randomization into two groups. Thirty patients in group A treated with bupivacaine 25 ml of 0.5% with dexamethasone 8mg (2 ML) and 30 in group B treated with bupivicaine 25 ml of 0.5% with dexmedetomidine 1µg/kg (2ml). Patients were observed in post-anesthesiacareunitpost-surgery. Duration of onset of pain was noted by patient’s first request for analgesia. Results:Themean age of patients was 34.88±9.39 years. Mean onset time of sensory and motor block was significantly low in group A than group B. Mean duration of sensory block and motor block was significantly high in group B than group A [813.87±113.72 vs. 752.63±27.96; p=0.006] and [734.13± 84.44 vs533.07±88.38;p=0.0005]. The time to request for 1st rescue analgesic was significantly increased in group B as compare to group A(p=0.0005). Practical Implication: Regional anesthesia in orthopedic procedures is superior to general anesthesia in terms of better postoperative pain relief, less central nervous system depressant effect of drugs and early discharge from hospital. Conclusion:The duration of block prolonged in cases where dexmedetomidine was added to the bupivacaine was longer but onset was reduced in comparison to the dexamethasone cases. Keywords: Brachial plexus block, Supraclavicular block, Dexmedetomidine, Dexamethasone

Ultrasound-Guided Thoracolumbar Interfascial Plane Block with and Without Dexamethasone: A Comparative Study in Patients Undergoing Lumbar Spine Surgeries

ABSTRACT Background: Thoracolumbar interfascial plane (TLIP) block is a novel regional anesthetic technique that can provide effective postoperative analgesia in patients undergoing lumbar spine surgeries. This block targets the dorsal rami of thoracolumbar nerves as they pass through the paraspinal muscles. Multilevel spine surgeries are often prolonged, requiring extended duration of postoperative analgesia. Objective: To compare the duration and quality of postoperative analgesia of TLIP block when given with and without dexamethasone as an additive to bupivacaine. Methodology: This was a prospective, double-blinded randomized study done on 20 patients undergoing two- or three-level lumbar spine surgeries. Ten patients in group C received 20 ml of 0.25% bupivacaine alone, whereas 10 patients in Group D received 8 mg dexamethasone along with 20 ml of bupivacaine for TLIP block before skin incision. Time for first analgesic request and pain scores using Wong–Baker Faces Pain Rating Scale were measured postoperatively. Results: The mean duration of sensory block was longer in group D when compared to group C (502.00 ± 95.13 vs. 383.5 ± 54.53 min with a P value of 0.001). The amount of rescue analgesic requirement was also higher in group C compared to group D. Conclusion: Dexamethasone, as an additive to bupivacaine, prolongs the duration and improves the quality of TLIP block for lumbar spine surgeries.

A COMPARISON OF DEXMEDETOMIDINE AND BUPRENORPHINE AS AN ADJUVANT WITH 0.5% BUPIVACAINE IN PERIPHERAL NERVE STIMULATOR (PNS) GUIDED SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK - A PROSPECTIVE DOUBLE BLINDED RANDOMIZED CLINICAL STUDY

Background And Aims: We compared the block quality and characteristics between dexmedetomidine versus buprenorphine as an adjuvant to bupivacaine in Peripheral nerve stimulator guided supraclavicular brachial plexus block. The quality of block by dexemetomidine was found to be better than buprenorphine and thus has opioid sparing action. Duration of sensory and motor block along with duration of analgesia were the primary outcomes studied. Methods:Total 80 patients of either sex, 40 patients in each group presenting for upper limb surgeries Each participant fullling our inclusion criteria then included. Results: In our study group D represents the group that received dexemotomidine while group B represents the group that received buprenorphine Mean duration of sensory block in group D was (704.05± 123.16) min and in group B it was (543.25 ± 60.14) min while mean duration of motor block in Group D (& (662.05± 121.83) was longer than Group B (397.50±56.51) and Duration of analgesia in Group D (782.88 ±115.44) was also longer than Group B (636.25±53.62).The results were statistically signicant. Conclusion: Dexmedetomidine I dose of 1ug/kg prolongs the duration of sensory and motor blockade and duration of analgesia as compared with buprenorphine when used as an adjuvant to 0.5%bupivacaine in supraclavicular brachial plexus block, with no major adverse side effects

Efficacy of intravenous dexamethasone for post-operative pain relief in elective cesarean section

Background: Various additives have been evaluated for the purpose of enhancing quality of analgesia and prolonging duration of spinal anesthesia. Aims and Objectives: This randomized study was conducted to evaluate the efficacy of intravenous dexamethasone in spinal anesthesia. Materials and Methods: A total of 100 patients scheduled for lower segment cesarean section under spinal anesthesia were randomly allocated into two groups, Group-1 and Group-2, including 50 patients each. All the patients received injection bupivacaine 0.5% heavy 10 mg for spinal anesthesia. Group-1 received injection dexamethasone 8 mg intravenously, and Group-2 received injection normal saline 2 cc immediately after spinal anesthesia. Duration of sensory and motor block, post-operative analgesia, visual analog pain scale (VAS) score, time of rescue analgesia, total analgesic requirement in the first 24 h, intra- and post-operative hemodynamics, and side effects if any were recorded. Results: The mean duration of sensory block (min) in Group-1 and Group-2 was 162.50 and 106.17, respectively. Time to the requirement of first rescue analgesia was 8.67 h in Group-1 and 4.40 h in Group-2. Significant changes seen in VAS score in post-operative period after 1 h of surgery in Group-1 and Group-2. Group-1 had more duration of sensory block, prolonged requirement of first rescue analgesia. Duration of motor block and intra- and post-operative hemodynamic parameters was comparable in both the groups. No side effects were recorded in both the groups. Conclusion: We conclude that administration of dexamethasone 8 mg intravenously prolongs the duration of post-operative analgesia and sensory block in patients undergoing lower segment cesarean section under spinal anesthesia.

Comparison of Dexmedetomidine and Fentanyl as an Adjuvant to Ropivacaine in Ultrasoundguided Supraclavicular Brachial Plexus Block: A Prospective Observational Study

Introduction: Upper limb surgeries are mostly performed under supraclavicular brachial plexus blocks which provide intraoperative and postoperative analgesia. Ultrasound provides clinicians with real-time images which are useful for better identification of the anatomical structures, safe needle placement, and adequate local anaesthetic spread. Adding adjuvants to local anaesthetic drugs prolong the duration of anaesthesia without concomitantly increasing the risk of complication. Aim: To compare fentanyl and dexmedetomidine when added as an adjuvant to ropivacaine for Ultrasound-guided supraclavicular brachial plexus block. Materials and Methods: A prospective observational, doubleblinded study was conducted in the Department of Anaesthesia, at Government Medical College, Kottayam, Kerala, India, on 52 patients undergoing orthopaedic upper limb surgeries over a period of one year from April 2019-March 2020. Patients were divided into two groups of 26 subjects each. Group A received ropivacaine 0.5% (20 mL)+dexmedetomidine 1 mcg/kg and group B received ropivacaine 0.5% (20 mL)+Fentanyl 1 mcg/kg. Onset, time to complete sensory and motor block, duration of sensory and motor block, duration of analgesia, adverse effects and haemodynamic status were monitored. Statistical analysis was done using t-test and Chi-square test. Results: The demographic variables, onset of sensory and motor block were comparable in both the groups. Mean duration of sensory block in group A and B were 638.08±52.001 minutes and 568.85±36.478 minutes respectively. The mean duration of motor block in group A was 605.77±58.8 minutes and group B was 513.46±14.982 minutes. The mean duration of analgesia in group A and B were 722.3±58.13 and 615.00±48.19 minutes, respectively. Mean duration of sensory block, motor block and analgesia were found more in group A which was statistically significant with p-value=<0.05. There was no significant difference in haemodynamic parameters. Conclusion: Dexmedetomidine was a better adjuvant to 0.5% ropivacaine as compared to fentanyl in Ultrasound-guided supraclavicular brachial plexus block in terms of duration of sensory block, motor block and analgesia.

A COMPARATIVE STUDY OF THE EFFECTS OF INTRATHECAL MIDAZOLAM(1MG) AND FENTANYL(25 MICROGRAMS) AS ADDITIVES TO INTRATHECAL HYPERBARIC BUPIVACAINE 0.5%(15MG) IN SPINALANAESTHESIA

Background: Various intrathecal additives are added to local anesthetics to increase the speed of onset, improve the quality, and prolong the inuence of spinal anesthesia. Midazolam has a synergistic effect on postoperative analgesia when administered intrathecally with bupivacaine. Opioids such as fentanyl are extensively used as an adjunct to local anesthetics in neuraxial blockade to enhance the duration of postoperative analgesia. Aim: The aim of our study was to compare the effects of intrathecal midazolam(1mg) and fentanyl (25 micrograms) as additives to intrathecal hyperbaric bupivacaine 0.5% (15mg) with spinal anesthesia.Materials and Methods: Prospective, observational study was conducted at SRI SIDDHARTHAMEDICAL COLLEGE AND RESEARCH INSTITUTE,TUMKUR. from 1st Jan 2021 to 30th June 2022 on 94 patients. Results: In Bupivacaine and Midazolam group, mean duration of surgery was 84 ± 12.3 minutes and in Bupivacaine and Fentanyl group, mean duration of surgery was 92 ± 14.4 minutes. In Bupivacaine and Midazolam group, mean time for onset of sensory block was 7.1 ± 0.9 minutes and in Bupivacaine and Fentanyl group, mean time for onset of sensory block was 6.9 ± 1.1 minutes. In Bupivacaine and Midazolam group, mean time for onset of motor block was 7.6 ± 1.3 minutes and in Bupivacaine and Fentanyl group, mean time for onset of motor block was 8.1± 1.2 minutes. In Bupivacaine and Midazolam group, mean duration of sensory block was 213.6 ± 16.1 minutes and in Bupivacaine and Fentanyl group, mean duration of sensory block was 218.3 ± 19.2 minutes. Conclusion- The onset of sensory and motor blockade was comparable in Fentanyl with Bupivacaine and Midazolam with Bupivacaine. Additional of intrathecal Fentanyl prolonged the duration of analgesia signicantly than that of Midazolam. There was signicantly less consumption of rescue of analgesia among patients with Fentanyl with Bupivacaine than Midazolam with Bupivacaine. The duration of postoperative analgesia was also signicantly prolonged in the fentanyl and midazolam groups

A prospective, randomised, double blind study comparing dexamethasone and dexmedetomidine as adjuvants to 0.2% ropivacaine for post-operative analgesia in ultrasound guided brachial plexus block

The Adjuvants added to local anaesthetic increases the duration of post-operative analgesia and decreases the analgesic requirement in post-operative period. The study was conducted with the intent of comparing post-operative analgesic effect of Dexamethasone and Dexmedetomidine in ultrasound guided Brachial Plexus Block. A prospective, randomised, double blind study to compare post-operative analgesic effect of Dexamethasone and Dexmedetomidine as adjuvant to 0.2% Ropivacaine in Ultrasound Guided Brachial Plexus Block. 60 patients belonging to ASA I and ASA II scheduled for upper limb surgeries were included in the study after taking informed consent. Group A received 20ml of 0.2% Ropivacaine with 8mg of Dexamethasone. Group B received 20ml of 0.2% Ropivacaine with 50 µg of Dexmedetomidine. Our primary objective was to compare the time to first request for analgesia in both the groups. Secondary objective was to compare duration of sensory and motor block in post-operative period and to compare overall requirement for analgesia in 24 hours in both the groups. The mean duration of motor block in Dexamethasone group was 635.47 ± 26.29 minutes and in Dexmedetomidine group was 827.47 ± 54.62 minutes. Similarly, mean duration of sensory block was 681.5 ± 27.19 minutes in Dexamethasone group and 877.17 ± 52.85 minutes in Dexmedetomidine group. The mean duration of time to first rescue analgesic was 709.67+18.47 minutes in dexamethasone group and 910.2 ± 51.66 minutes in Dexmedetomidine group. Total analgesia given had significant statistical difference of 0.004 between the two groups, with mean of 1.23 ± 1.17 in Dexamethasone group and 0.4 ± 0.56 in Dexmedetomidine. However, at 2hr, 4hr, 8hr, 12hr, 18hr and 24 hr the difference in VAS scores was significant (p value <0.0001). Dexmedetomidine is better than Dexamethasone in prolonging duration of analgesia of the Brachial plexus block.

Ultrasonography guided supraclavicular brachial plexus block: comparison of sensori-motor blockade and duration of postoperative analgesia between ropivacaine and levo-bupivaine

The study was conducted to compare the onset time, duration and quality of analgesia between 0.5% levo-bupivacaine and 0.5% ropivacaine given in brachial plexus. This prospective, triple blind randomized controlled trial was conducted between January 2020 to December 2021. Seventy patients were randomly allocated into two groups of 35 patients each to receive USG guided brachial plexus block with 30 ml of 0.5% levo-bupivacaine or 30 ml of 0.5%ropivacaine. Blinded observer recorded the onset time and duration of brachial plexus block. Patient characteristics regarding age, weight, and surgical time were comparable in the two groups. The mean onset time of sensory blockade with 0.5% ropivacaine and 0.5%levo-bupivacaine was clinically comparable in our present study. The mean duration of sensory block with 0.5% ropivacaine and 0.5% levo-bupivacaine was also comparable in study. The mean onset time for motor block with 0.5%levo-bupivacaine was lesser than 0.5% ropivacaine. The mean duration of motor block observed in present study with 0.5% ropivacaine was lesser than 0.5% levo-bupivacaine. Mean duration of post operative analgesia of 485.0 ± 76.90 mins (8.08 hrs) was noted with 0.5%ropivacaine and 491.91 ± 92.99 mins (8.2 hrs) with 0.5%levo-bupivacaine which was clinically comparable and the difference was statistically insignificant.

ASSOCIATION DEXMEDETOMIDINE AND DEXAMETHASONE AS AN ADJUVANT TO LEVOBUPIVACAINE FOR SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK IN PATIENTS UNDERGOING UPPER LIMB SURGERIES.

Introduction: Brachial plexus block has evolved into an excellent substitute to general anaesthesia for upper limb surgeries. By curtailing the 1 stress response and using minimal anaesthetic drugs it provides intraoperative analgesia along with prolonged postoperative pain-relief. Varied avenues of brachial plexus blockade exist namely interscalene, supraclavicular, infraclavicular and axillary approach. With swift onset of dense anaesthesia of upper limb, supraclavicular brachial plexus block (SCBP) block is considered as the 'spinal of the arm. Objective: To conduct a comparative evaluation between Dexmedetomidine and Dexamethasone as an adjuvant to Levobupivacaine for supraclavicular brachial plexus block inpatients undergoing upper limb surgeries. Material and Methods: This is a prospective randomized controlled intervention study was Patients undergoing elective upper limb surgeries under supraclavicular brachial plexus block at orthopaedic surgery rooms of MGM Medical College From March 2019 to August 2020 Patients aged between 20-60 years of either sexes. Patients belonging to ASA Grade I and ASA Grade II and Patients scheduled for elective upper limb surgeries under supraclavicular brachial plexus block in included in this study. Result: The mean Onset of sensory block (mean± s.d.) of patients was higher in Group-C [13.2333± 1.6333 Mins] compared to Group-S patients [11.2000± 1.1265(Min)] which was statistically signicant (p<0.0001). the mean Duration of Sensory Block (mean± s.d.) of patients was higher in Group-S [753.5667± 5.2172 (Min)] compared to Group-C patients [718.2333± 25.7504 (Min)] which was statistically signicant (p<0.0001). the mean Duration of Motor Block (mean± s.d.) of patients was higher in Group-S [708.5667± 4.2644 (Min)] compared to Group-C patients [682.3667± 20.0095 (Min)] which was statistically signicant (p<0.0001). Conclusion: The difference of mean Fingers 0 (p=0.6311), Fingers 5 (p=0.8860), Fingers 10 (p=1.0000), Fingers 15 (p=1.0000), Fingers 20 (p=1.0000), Fingers 25 (p=0.5936) and Fingers 30 (p=0.8469) with both Groups were not statistically signicant. Bromage Score 0 (p=0.8469), Bromage Score 5 (p=0.8355), Bromage Score 10 (p=0.5693), Bromage Score 15 (p=0.5671), Bromage Score 20 (p=0.5671), Bromage Score 25 (p=0.6973) and Bromage Score 30 (p=0.7176) with both Groups were not statistically signicant.

Comparison of intrathecal fentanyl and buprenorphine as adjuvants to bupivacaine in gynecological surgery

Background & Objective: Hyperbaric bupivacaine is the most commonly used local anesthetic for spinal anesthesia, alone or in combination with various adjuvants. Opioids are frequently used for their rapid onset and intense block characteristics. Fentanyl is the preferred intrathecal opioids with rapid onset of action but has a shorter duration of action. Buprenorphine is a mixed agonist-antagonist with high affinity at both mu and kappa opioid receptors. We compared administration of buprenorphine with fentanyl as adjuvants with intrathecal hyperbaric bupivacaine in gynecological surgeries.
 Methodology: After Institutional Ethical Committee approval and written informed consent, 60 patients aged 18–65 y, scheduled for lower abdominal gynecological surgery, were divided into two equal groups; Group F to receive 0.5% hyperbaric bupivacaine 2.5 ml with fentanyl 25 µg intrathecal and Group B to receive 0.5% hyperbaric bupivacaine 2.5 ml with buprenorphine 75 µg intrathecal. Block characteristics and associated side effects were compared between two groups. The data was analyzed using Chi square test and Fisher’s exact test. For comparing two group of mean, independent student’s t test was used. P-value < 0.05 was considered as statistically significant.
 Results: The mean onset of sensory and motor block was significantly earlier in Group F than Group B (p < 0.001). Mean duration of sensory block was significantly prolonged in Group B compared to Group F (p < 0.05). Whereas, the duration of motor was comparable in both of the groups (p > 0.05). Duration of analgesia was significantly prolonged in Group B than Group F (p < 0.001).
 Conclusion: We conclude that when a longer duration of postoperative pain relief is needed, buprenorphine can be a suitable drug to be used with intrathecal hyperbaric bupivacaine for gynecological surgeries because of prolonged duration of action.
 Key words: Spinal anesthesia; Fentanyl; Buprenorphine; Bupivacaine
 Citation: Singh Y, Yadav AK, Vijeta Bajpai, Diwedi P, Verma S, Verma RK. Comparison of intrathecal fentanyl and buprenorphine as adjuvants to bupivacaine in gynecological surgery. Anaesth. pain intensive care 2021;26(1):39-43.
 DOI: 10.35975/apic.v26i1.1764

A COMPARISON BETWEEN INTRATHECAL NALBUPHINE VERSUS FENTANYL AS AN ADJUVANT WITH 0.5% HYPERBARIC BUPIVACAINE FOR POSTOPERATIVE ANALGESIA IN PATIENTS UNDERGOING LOWER SEGMENT CESAREAN SECTION

Background: Subarachnoid block is the preferred anesthesia for cesarean section, being simple to perform and economical with rapid onset. This study aims to compare the postoperative analgesia of intrathecal nalbuphine and fentanyl as adjuvants to bupivacaine in cesarean section.
 Methods: A prospective, randomized, double?blind, and comparative study was conducted on 120 patients of American Society of Anesthesiologists (ASA) physical status I and II. These patients were randomized into three groups with fifty patients in each group. Group A received 2 ml of 0.5% hyperbaric bupivacaine (10 mg) plus 0.4 ml nalbuphine (0.8 mg), Group B received 2 ml of 0.5% hyperbaric bupivacaine (10 mg) plus 0.4 ml fentanyl (20 ?g), and Group B received 2 ml of 0.5% hyperbaric bupivacaine (10 mg) plus 0.4 ml of normal saline.
 Results: The mean duration of sensory block was 107.32 ± 5.36 min in Group A, 111.23 ± 4.23 min in Group B, and 85.69 ± 2.31 min in Group C. The mean duration of motor block (time required for motor block to return to Bromage’s Grade 1 from the time of onset of motor block) was 152.02 ± 3.12 min in Group A, 151.69± 2.36 min in Group B, and 122.12 ± 2.32 min in Group C.
 Conclusion: We concluded that intrathecal nalbuphine prolongs postoperative analgesia maximally and may be used as an alternative to intrathecal fentanyl in cesarean section.
 Keywords: Nalbuphine, Bupivacaine, Fentanyl.

Effect of verapamil as an adjuvant to Levobupivacaine in supraclavicular brachial plexus block

Background: The quest for searching newer and safer anaesthetic agents has always been one of the primary needs in anaesthesiology practice. Levobupivacaine, the pure s (-) enantiomer of bupivacaine, has strongly emerged as a safer alternative for regional anaesthesia than its racemic sibling. Also, many adjuvants have been used with local anaesthetics to reduce the time of onset and prolong the duration of analgesia in brachial plexus blocks. However, few studies are there using verapamil as an adjuvant with Levobupivacaine.Aims: The primary aim of the study is to know the effect of verapamil (5mg) as an adjuvant to Levobupivacaine in supraclavicular brachial plexus block.Methods: A Descriptive, Observational study was carried out in 80 ASA Grade I and II patients, undergoing upper limb surgeries under supraclavicular brachial plexus block using ultrasound machine. Local anaesthetic solution was prepared as following. 30ml 0.5% Levobupivacaine + 2ml Verapamil (5mg). The effect of Verapamil as an adjuvant to Levobupivacaine in Supraclavicular Brachial Plexus Block with regards to onset and duration of motor and sensory block, duration of analgesia, need for rescue analgesia and number of rescue analgesia in first 24 hours after surgery was evaluated. Data analysis was done with the help of SPSS Software ver 13.Results: Mean onset time for motor block in our study group was 9.19 ± 1.86minThe mean duration of motor block in our study group was 470.25 ± 42.00 minThe mean onset time for sensory block in our study group was 6.48 ± 2.55 minThe mean duration of sensory block in our study group was 494.88 ± 37.67 minThe mean duration of analgesia in our study group was 517.88 ± 48.24The mean no of reuse analgesia required in the first 24 hours after surgery was 3Conclusion: Verapamil (5 mg) 2 ml can be effectively and safely used as an adjuvant to Levobupivacaine (0.5%) 30ml in Supraclavicular Brachial Plexus Block. However, due to paucity of studies in literature, there is still scope for further study using different calcium channel blocking drugs or in different dosage strengths.

Intrathecal Use of Isobaric Levobupivacaine 0.5% Versus Isobaric Ropivacaine 0.75% for Lower Abdominal and Lower Limb Surgeries.

BackgroundThis study was undertaken to compare and evaluate the efficacy of 3-ml 0.5% isobaric levobupivacaine versus 3-ml 0.75% isobaric ropivacaine in patients undergoing elective lower abdominal and lower limb surgeries.MethodsWe allocated 60 patients into two groups (n=30 each) to receive either a spinal block of 3-ml 0.5% isobaric levobupivacaine (group L) or 3-ml 0.75% isobaric ropivacaine (group R). Haemodynamic parameters were measured intraoperatively till the end of surgery and postoperatively for two hours. The onset and duration of sensory block and motor block were recorded. Adverse events were also recorded. The student’s unpaired t-test was used for comparing the continuous variables.ResultsThe mean age in group L was 37.83 ±16.51 years and the mean age in group R was 38.50 ±12.97 years. The mean onset of sensory block in group L (6.97 ±1.82 mins) was significantly faster than in group R (8.47 ±2.55 mins), p<0.05. Similarly, so was the mean onset of motor block in group L (10.27 ±1.92 mins) versus group R (12.93 ±2.55 mins), p<0.05. The mean duration of sensory block in group L (147.63 ±27.53 mins) was significantly longer than in group R (97.40 ±12.38 mins), p<0.05, as was the mean duration of motor block in group L (207.33 ±22.27 mins) versus group R (146.60 ±21.22 mins), p<0.05. In group L, 13.3% of patients had complications, with hypotension being the most common (6.7%); in group R, 40% had complications, of which bradycardia was the most common (13.3%).ConclusionThere was an earlier onset of sensory and motor block and prolonged duration of sensory and motor block with intrathecal administration of 3-ml 0.5% isobaric levobupivacaine as compared to 3-ml 0.75% isobaric ropivacaine. Haemodynamic parameters were more stable with levobupivacaine than ropivacaine. Adverse effects were more common with ropivacaine.

Prolonged Duration Local Anesthesia by Combined Delivery of Capsaicin- and Tetrodotoxin-Loaded Liposomes.

Capsaicin, the active component of chili peppers, can produce sensory-selective peripheral nerve blockade. Coadministration of capsaicin and tetrodotoxin, a site-1 sodium channel blocker, can achieve a synergistic effect on duration of nerve blocks. However, capsaicin can be neurotoxic, and tetrodotoxin can cause systemic toxicity. We evaluated whether codelivery of capsaicin and tetrodotoxin liposomes can achieve prolonged local anesthesia without local or systemic toxicity. Capsaicin- and tetrodotoxin-loaded liposomes were developed. Male Sprague-Dawley rats were injected at the sciatic nerve with free capsaicin, capsaicin liposomes, free tetrodotoxin, tetrodotoxin liposomes, and blank liposomes, singly or in combination. Sensory and motor nerve blocks were assessed by a modified hotplate test and a weight-bearing test, respectively. Local toxicity was assessed by histologic scoring of tissues at the injection sites and transmission electron microscopic examination of the sciatic nerves. Systemic toxicity was assessed by rates of contralateral nerve deficits and/or mortality. The combination of capsaicin liposomes and tetrodotoxin liposomes achieved a mean duration of sensory block of 18.2 hours (3.8 hours) [mean (SD)], far longer than that from capsaicin liposomes [0.4 hours (0.5 hours)] (P < .001) or tetrodotoxin liposomes [0.4 hours (0.7 hours)] (P < .001) given separately with or without the second drug in free solution. This combination caused minimal myotoxicity and muscle inflammation, and there were no changes in the percentage or diameter of unmyelinated axons. There was no systemic toxicity. The combination of encapsulated tetrodotoxin and capsaicin achieved marked prolongation of nerve block. This combination did not cause detectable local or systemic toxicity. Capsaicin may be useful for its synergistic effects on other formulations even when used in very small, safe quantities.

A STUDY TO COMPARE THE EFFECT OF DEXMEDETOMIDINE AND CLONIDINE AS AN ADJUVANT TO ROPIVACAINE FOR EPIDURAL ANESTHESIA IN INFRAUMBILICAL SUGERIES

Background: Alpha-2 adrenergic agonists have both analgesic and sedative properties and can be used as an effective adjuvant in epidural anaesthesia. The aim of our study to compare the efficacy and clinical profile of α-2 adrenergic agonists dexmedetomidine and clonidine, when used as adjuvants in epidural anaesthesia in patients undergoing infraumbilical surgeries with special emphasis on their sedative properties and ability to provide smooth intra-operative and post- operative analgesia.&#x0D; Methods: This Hospital Based, double blind, randomized, comparative, interventional Study was carried out in 60 patients undergoing infra umbilical surgeries. After obtaining permission from Institutional Ethics Committee and Research Review Board. All patients randomly allocated in two groups of 30 patients in each group. Group A patient received 15 ml 0.75 % ropivacaine + 1 microgram/kg dexmedetomidine, Group B received 15 ml 0.75 % ropivacaine + 1 microgram/kg clonidine.&#x0D; Results: The time of onset of sensory block with dexmedetomidine was earlier compared to clonidine (8.3+1.26 min versus 11.6+1.81min). Mean time to attain highest sensory level was 13.3± 1.4 minutes in group A and 17.6± 1.9 minutes in group B. Mean duration of sensory block was 306.1 ± 8.32 minutes in group A and 285.2 ± 17.4 minutes in group B. Mean time to motor onset was 17.7±3.3 minutes in group A and 18.8±2.9 minutes in group B. Mean duration of motor block was 241.1 ± 4.81 minutes in group A and 216.9± 7.17minutes in group B. There was no significant difference in VAS score till half an hour and after one hour we got significant difference in both groups.&#x0D; Conclusion: We concluded that when used with ropivacaine (0.75%) as an adjuvant dexmedetomidine (1microgram/kg) and clonidine (1microgram/kg) shortens the onset of sensory block, prolongs the duration of sensory and motor blockade and provides the effective and prolonged post operative analgesia with adequate sedation and without major adverse effects and hemodynamic changes.&#x0D; Keywords: Clonidine, dexmedetomidine, epidural, ropivacaine.

A study of comparison of the efficacy of 0.5 percent Levobupivacaine with a combination of 0.5 percent Levobupivacaine and hyaluronidase, in ultrasound guided axillary brachial plexus block for forearm and hand surgeries

Background: Axillary block is a regional anesthesia for surgeries at and below the elbow. Complications associated with peripheral blocks using blind approaches are addressed with advent of ultrasound guidance. Hyaluronidase drug works as a spreading factor. Combination of ultrasound guidance and hyaluronidase in addition to local anesthetics in peripheral blocks will increase efficacy and reduce complications. Objective: The objective of the study is to compare the efficacy of 0.5% Levobupivacaine with a combination of 0.5% Levobupivacaine and hyaluronidase in USG guided axillary brachial plexus block for forearm and hand surgeries with respect to: Onset of sensory and motor block, duration of sensory block and time to rescue analgesia. Materials and Methods: After institutional ethical committee clearance 60 ASA PS class 1 and 2 adult patients in age group of 18 to 60 year who underwent elective upper limb surgeries in sridevi institute of medical sciences, tumkur from October 2017 to dec 2019 were included. Any patient with history of bleeding disorders, documented neuromuscular disorders, known allergy to Local anesthetics drugs, Psychiatric patients and if on anticoagulants were excluded from the study. Patients were alternately assigned to two groups Group A and Group B each containing 30 patients Patients undergoing Ultrasound guided Axillary Brachial plexus block with. GROUP A – 20 ml of 0.5% Levobupivacaine and Hyaluronidase 300 Units (15U/ml of local anesthetic) GROUP B – 20 ml of 0.5% Levobupivacaine. The patients were given Ultrasound guided Axillary brachial plexus block. onset of sensory blockade, onset of motor blockade, sensory block duration and time to rescue analgesia were compared. Results: The mean onset of sensory block in group A was 10.10±0.9 minutes and group B was 13.33±0.9 minutes. The mean onset of motor block in group A was 11.73±1.66 minutes and in group B was 14.23±1.45 minutes. The mean duration of sensory block in group A was 7.8±1.0 hours and in group B was 10.8±2.0 hours the mean time to rescue analgesia in group A was 9.9±1.3 hours and in group B was 12.2±2.0hours. Conclusion: In ultrasound guided axillary brachial plexus block using 0.5% levobupivacaine, addition hyaluronidase reduces onset of sensory and motor block time therefore shortens the total anaesthetic time before the operation. It also reduces the duration of post operative sensory block time and time to requirement of rescue analgesia.

A Comparative Study of Intrathecal Bupivacaine and Bupivacaine with Different Doses of Clonidine in Lower Limb Surgeries.

Background:Intrathecal clonidine is a very safe, nonopioid adjuvant to local anesthetics to prolong the duration of analgesia without any major side effects.Objective:The purpose of the present study was to evaluate the efficacy of clonidine in two different doses as an adjuvant to bupivacaine intrathecally in lower limb surgeries.Materials and Methods:A total of 75 adult patients scheduled to undergo lower limb surgeries were randomly allocated into either of three groups of 25 patients. Group I received 12.5 mg bupivacaine, Group II patients received bupivacaine 12.5 mg with clonidine 15 μg, and patients in Group III received bupivacaine 12.5 mg with clonidine 30 μg intrathecally. A total volume of 3 ml was made in all groups using normal saline. The hemodynamic parameters, onset, and duration of sensory block, highest dermatomal level of sensory block, motor block onset, time to complete motor block recovery, and mean time to request of the first analgesic were recorded. Side effects or any other complications were noted.Results:The mean time of onset of sensory block and motor block was less in clonidine groups. The mean duration of sensory block was significantly prolonged in clonidine groups as compared to study group. The duration of motor block (in minutes) was significantly prolonged in Group III (171.60 ± 38.20) as compared to Group I (113.20 ± 35.79) and Group II (115.20 ± 38.41). The time of analgesic request in Group I was 148.16 ± 43.99 min, 190.60 ± 38.08 in Group II, and 200.80 ± 59.85 min in Group III.Conclusions:The addition of intrathecal clonidine 15 μg to small dose bupivacaine increased the spread, duration of analgesia, and produced effective spinal anesthesia with stable hemodynamics and did not prolong postoperative motor block.