Μg Fentanyl Research Articles

Perbandingan bupivacain 0,5% 15 mg dan fentanil 25 mcg dengna bupivacain 0,5% 15 mg terhadap nilai oksigenasi pada pasien dengan anestesi spinal

Background: Spinal anesthesia is a safe anesthetic technique for elective and emergency surgeries. Spinal anesthesia adversely affects cerebral oxygenation, especially when fentanyl is administered as an adjuvant to spinal anesthesia.Objectives: To determine the difference in cerebral oxygenation values between patients undergoing spinal anesthesia using bupivacaine 0,5% with fentanyl and bupivacaine 0,5% in patients undergoing spinal anesthesia.Methods: This was an analytic post-test experiment with a cross-sectional design. This study was conducted at the Haji Adam Malik Hospital Medan, with a total sample of 36 patients. The research group was divided into groups that received bupivacaine 0,5% 15 mg and bupivacaine 0,5% 15 mg plus fentanyl 25 µg. The rSO2 value was assessed before spinal action (T0), shortly after spinal anesthesia (T1), and 15 min after spinal anesthesia (T2). Near-infrared spectroscopy was used as the measurement instrument. Data to be collected were analyzed with a bivariate, independent T-test and Mann-Whitney test with a 95% confidence interval (CI).Results: The average rSO2 values of patients who received bupivacaine were 64,0% on the right and 65,1% on the right and left sides, respectively. The average rSO2 values of patients who received bupivacaine were 74,8% on the right and 76,1% on the left. There was a significant difference in blood pressure and rSO2 values in patients who received 0,5% bupivacaine spinal anesthesia with 0,5% bupivacaine added to 25 µg fentanyl (p <0,05).Conclusion: There was a significant difference in rSO2 values between patients who received 0,5% bupivacaine spinal anesthesia with 0,5% bupivacaine plus 25 µg fentanyl.

Intrathecal midazolam is a comparable alternative to fentanyl and nalbuphine as adjuvant to bupivacaine in spinal anesthesia for elective Cesarean Section; a randomized controlled double-blind trial

Background: Different adjuvants have been introduced to enhance the quality of local anesthetics and reduce its adverse events. This study was directed to compare the anesthetic and analgesic properties of intrathecal hyperbaric bupivacaine when three different adjuvant drugs were added.
 Methodology: One hundred full-term parturients aged 18 to 40 years, scheduled for elective cesarean section, were randomly assigned to 4 groups. Each group received 12.5 mg of 0.5% hyperbaric bupivacaine combined with either 0.5 ml saline (Group-B), 25µg fentanyl (Group-F), 0.8 mg nalbuphine (Group-N) or 2 mg midazolam (Group-M). The outcomes included the postoperative effective analgesia time, the sensorimotor characteristics, postoperative VAS score, pethidine consumption, maternal complications, and neonatal Apgar score.
 Results: Earlier onset of sensory and motor block was observed in Group F and N than in Group B and M. Duration of postoperative effective analgesia was longer in Groups F, N and M (252.42 ± 46.11, 227.34 ± 36.54 and 243.71 ± 44.95 hours, respectively) than in Group B (172.11 ± 20.99) (P < 0.001). VAS scores decreased in adjuvant groups during the first 12 hours postoperative and required pethidine doses were less.
 Conclusion: Addition of adjuvant agents to intrathecal bupivacaine improved the quality of subarachnoid block without increasing side-effects. Intrathecal midazolam provided comparable outcomes as the frequently used opioids.
 Abbreviations: CS: Cesarean section; LA: Local anesthetics; SA: Spinal anesthesia
 Key words: Intrathecal; Nalbuphine; Midazolam; Fentanyl; Postoperative analgesia; Cesarean section.
 Citation: Amin SR, Souidan I, Abdelzaam EM. Intrathecal midazolam is a comparable alternative to fentanyl and nalbuphine as adjuvant to bupivacaine in spinal anesthesia for elective cesarean section: a randomized controlled double-blind trial. Anaesth. pain intensive care 2022;27(1):89−96; DOI: 10.35975/apic.v27i1.1923
 Received: June 26, 2022; Reviewed: November 28, 2022; Accepted: December 14, 2022

A Randomized, Double-Blind, Graded Dose-Response Study of Norepinephrine Administration for Prevention of Post-Spinal Hypotension during Elective Cesarean Delivery.

Norepinephrine has been recently introduced for prophylaxis against post-spinal hypotension during cesarean delivery; however, no data are available regarding its optimum dosing scheme. The primary objective of this study is to compare three different infusion and bolus dose combinations of norepinephrine for prophylaxis against post-spinal hypotension during cesarean delivery. This randomized, double-blind study was performed between February 2021 and May 2022. The study protocol was registered at Clinicaltrials.gov with the identification number NCT04701190. A total of 192 parturients were enrolled into this study. Patients were assigned to three groups-Zero-Bolus High-Infusion (Group ZBHI, 0 µg/0.1 µg kg-1 min-1, n = 61), Moderate-Bolus Moderate-Infusion (Group MBMI, 5 µg/0.075 µg kg-1 min-1, n = 61) and High-Bolus Low-Infusion (Group HBLI, 10 µg/0.05 µg kg-1 min-1, n = 61)-according to different combinations of norepinephrine infusion and bolus doses. All patients received spinal anesthesia with 10 mg hyperbaric bupivacaine plus 12.5 µg fentanyl. Immediately after cerebrospinal fluid was obtained, patients underwent a norepinephrine protocol corresponding to the randomized group. The primary outcome was the incidence of post-spinal hypotension. Secondary outcomes were post-delivery hypotension, frequency of post-spinal hypertension and bradycardia, and neonatal outcomes. The incidence of post-spinal hypotension was 11.7% in Group HBLI, 6.7% in Group ZBHI and 1.7% in Group MBMI (p = 0.1). The overall incidence of post-delivery hypotension in parturients was 41.1% (p = 0.797). The lowest frequency of post-spinal bradycardia (8.3%) and hypertension (11.7%) was seen in Group HBLI. The neonatal APGAR scores at 1st minute were higher in Group MBMI than in Group ZBHI (8.58 vs. 8.23, p = 0.001). All three infusion and bolus dose combinations of norepinephrine effectively reduced the incidence of post-spinal hypotension. However, high-dose bolus (10 µg) followed by low-dose infusion (0.05 µg kg-1 min-1) of norepinephrine can be preferred due to the reduced frequency of bradycardia and hypertension during cesarean delivery under spinal anesthesia.

Evaluation of Ultrasound- Guided Quadratus Lumborum Block for Postoperative Analgesia after Hip Surgery

Abstract Background With improvement of surgical technique, hip surgery became more frequent with increased need for adequate postoperative analgesia The main advantage of quadratus lumborum block (QLB) compared to spinal anaesthesia is the extension of local anesthetic agent beyond the transverses abdominis plane to the thoracic paravertebral space producing extensive analgesia and prolonged action. Aim of the Work to assess the analgesic efficacy of ultrasound-guided (US) trans-muscular QLB compared to spinal anaesthesia during Hip surgery and in the early postoperative period regarding pain relief, provision of comfort, and improved respiratory functions. Patients and Methods 64 patients were randomly allocated to one of 2 groups (n = 32; each); group QLB received US-guided QLB before induction of spinal anesthesia using 0.2 ml/kg bupivacaine 0.25%. Group Spinal Anaesthesia alone: received Spinal anaesthesia alone, 3.5 ml of 0.5% bupivacaine plus 25 µg fentanyl. QLB results in decreased incidence and severity of postoperative pain resulting in a decrease in incidence and degree of sedation and total opioid requirement. The quadratus lumborum block was more efficient than the spinal anaesthesia alone. The first rescue for analgesia (pethidine), total pethidine consumption and pain scores (visual analog scale) in QLB group were superior to that for the spinal anaesthesia group. Conclusion patients having preoperative single shot QLB, as an adjuvant to spinal anesthesia, have significant less time for discharge from the postoperative care unit and better postoperative pain control compared to spinal anesthesia alone for hip surgery, in terms of VAS score and total opioid consumption as well as frequency of need.

Comparative study between dexmedetomidine and fentanyl as adjuvants to bupivacaine for postoperative epidural analgesia in abdominal surgeries: A randomized controlled trial

ABSTRACT Background Epidural analgesia is an efficient strategy to relieve postoperative pain after abdominal surgeries. This study aimed to evaluate dexmedetomidine or fentanyl when added to bupivacaine, providing postoperative epidural analgesia after abdominal procedures. Patients and methods Epidural catheter was placed on 75 patients scheduled for lower abdominal procedures under general anesthesia, and they were randomly assigned into three equal groups. Epidural analgesia was activated before the procedure was completed by injection of bupivacaine (0.125%) plus dexmedetomidine or fentanyl or normal saline mixture, according to the study groups. After complete recovery from general anesthesia, the epidural block was evaluated. Then, the infusion started through an elastomeric pump with an infusion rate of 5 ml/hr and continued for 24 hr postoperatively. Group D Dexmedetomidine 1 ml (100 μg) plus normal saline 1 ml were added to bupivacaine (0.125%) 48 ml (a total volume of 50 ml). Group F: 2 ml (100 μg) fentanyl was added to bupivacaine (0.125%) 48 ml (a total volume of 50 ml). Group C: Normal saline 2 ml was added to bupivacaine (0.125%) 48 ml (a total volume of 50 ml). Measured outcomes Primary outcomes The onset of sensory analgesia (from the beginning of epidural infusion until scoring 1 on a 3-point scale) and the duration of analgesia (from the start of epidural infusion till the first demand for further pain medication) were observed and recorded. Secondary outcomes Postoperative pain was evaluated using a visual analogue scale (VAS), and the number of patients requesting additional analgesia with pethidine over paracetamol as well as the pethidine consumption during postoperative 24 hr were recorded. The hemodynamic parameters, including heart rate (HR) and mean arterial blood pressure (MAP), were monitored and recorded at baseline, 2, 6, 12, and 24 hr, and any adverse events were properly recorded and managed during the study period. Results The dexmedetomidine group showed an earlier onset and longer duration of analgesia, with a highly significant difference (P-value <0.001) than other groups. The study groups differed significantly concerning pethidine needs and consumption (P-value <0.05). The VAS revealed a considerable decrease in the dexmedetomidine group compared to other groups, with a significant difference (P-value <0.05) at the intervals of (baseline, 12 hr, and 24 hr) and a highly significant difference (P-value <0.001) at the intervals of (2 and 6 hr). Postoperative blood pressure and heart rate measurements in the dexmedetomidine group were lower than in other groups. MAP showed a statistically highly significant difference at 6 and 24 hr (P-value <0.001) and a significant difference after 12 hr (P-value <0.05), while HR showed a statistically significant difference after 6 hr (P-value <0.05) and a highly significant difference at 12 and 24 hr (P-value <0.001). Regarding postoperative adverse events, no statistical difference was detected between groups except in pruritis and dry mouth. Conclusion Dexmedetomidine is preferred to fentanyl when added to epidural bupivacaine to relieve pain after abdominal procedures.

Stifling the sneeze in ACHOO syndrome-What the anesthesiologist should know.

Dear Editor, A 32-year-old male, a known patient of ocular amyloidosis, was posted for superficial keratectomy (removal of the corneal epithelium up to Bowman membrane) of the right eye under topical anesthesia. This patient had a history of photic sneeze reflex (PSR) since 12 years of age and was a diagnosed case of autosomal dominant compelling helio-ophthalmic outburst (ACHOO) syndrome. This condition is characterized by uncontrollable sneezing episodes on exposure to bright light or periocular injection including peribulbar block or eyelid infiltration. He suffered from continuous sneezing episodes lasting around 5 min even in response to slit-lamp examination. This was usually followed by a refractory period during which the ophthalmic examination was conducted. He had no other systemic illness. On the day of the procedure, he developed an irrepressible sneezing reflex after cleaning and draping of the right eye in the operating room. The ambient light had stimulated the PSR. The anesthesiologist was called for help. On clinical examination, the patient’s vitals were stable with a heart rate of 62/min, SpO2 98%, and blood pressure 100/70 mmHg. His sneezing fit had ceased but the patient was extremely anxious. An intravenous line was secured and he was administered midazolam 1 mg and fentanyl 50 μg intravenously. He became calm and allowed the gentle insertion of a wire speculum but still could not look at the light of the operating microscope though there were no more sneezing episodes. He was given another 50 μg fentanyl intravenously and reassured. The procedure was completed smoothly in 10 min. No further drugs were administered nor were there any sneezing episodes. A syringe filled with injection pheniramine maleate 22.75 mg was kept ready but was not required. Five days later, he was posted for superficial keratectomy of the other eye under monitored anesthesia care. The same anesthetic technique was followed and he was administered midazolam 1 mg and fentanyl 100 μg in small aliquots even before skin preparation. The procedure was completed uneventfully under topical anesthesia without a single sneezing episode. Sneezing fit after exposure to bright light or “sun sneezing” has been reported in about 25% of the population. These patients are also prone to a sternutatory reflex after local anesthetic injection under sedation.[1] Unexpected or sudden head movement during peribulbar block or eye surgery can cause globe perforation or vascular injury and retrobulbar hemorrhage.[2] PSR is a primitive brainstem reflex, sometimes considered a variant of the trigemino-cardiac reflex with the center in the trigeminal nucleus and adjacent reticular formation. The afferent arc is from the first (ophthalmic) and second (maxillary) division of the trigeminal nerve (VN) and the efferent is the vagus nerve. A cross-talk between the optic nerve (IIN) and VN has also been hypothesized.[3] No known treatment exists except avoidance. Few authors have found deep sedation, eyelid infiltration, midazolam, and propofol to increase the risk while opioids, dexmedetomidine, and antihistamines have been found to reduce the risk.[2,4] Some have even suggested PSR as an indication for general anesthesia in ophthalmic surgery.[5] It is important for anesthesiologists routinely caring for patients for ophthalmic surgery to be aware of this reflex as it can have severe sight-threatening consequences. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Dexmedetomidine vs. fentanyl as adjuvants to hyperbaric bupivacaine for unilateral spinal anesthesia in lower limb orthopedic surgeries: a randomized trial

Background &amp; Objective: Opioids and α2 adrenergic receptor agonists are commonly used as adjuvants to intrathecal local anesthetics to improve the quality and duration of spinal anesthesia (SA). Fentanyl and dexmedetomidine (DEX) are the most commonly used opioid and α2 agonist respectively. We compared the efficacy of these two when used as adjuvants to hyperbaric bupivacaine for SA for lower limb surgeries.&#x0D; Methods: A total of 54 patients were randomly assigned to receive unilateral spinal anesthesia with bupivacaine 2.5 ml. Group F (n = 27) received 25 μg fentanyl, and Group D received 10 μg DEX added to the spinal bupivacaine. Time to first analgesic request was the primary outcome, while sensory and motor block characteristics, nalbuphine consumption as rescue analgesic, pain scores, side effects and sedation levels were the secondary outcomes.&#x0D; Results: Patients receiving dexmedetomidine as an adjuvant to hyperbaric bupivacaine for spinal anesthesia for lower limb surgeries had a significantly longer time to rescue analgesia than those receiving fentanyl. The mean time to rescue analgesia in Group D was 409.63 ± 74.60 min vs. 295.93 ± 36.72 min (P = 0.000) in the Group F. Also, patients in Group D had significantly longer sensory and motor blocks.&#x0D; Conclusion: Intrathecal dexmedetomidine 10 μg seems to be a good alternative to fentanyl 25 μg when used as an adjuvant in unilateral spinal anesthesia for lower limb orthopedic surgeries with better quality postoperative analgesia and with minimal side effects.&#x0D; Abbreviations: DEX - Dexmedetomidine; NYHA - New York Heart Association; BMI - Body mass index; MBP - Mean blood pressure; SBP- Systolic blood pressure; DBP- Diastolic blood pressure; VAS - Visual Analog Scale&#x0D; Key words: Dexmedetomidine; Fentanyl; Bupivacaine; Anesthesia, Spinal&#x0D; Citation: Ghaly SI, Shafik AM, AlTaher WAMM, Motawashleh MG, Alansary AM. Dexmedetomidine vs. fentanyl as adjuvants to hyperbaric bupivacaine for unilateral spinal anesthesia in lower limb orthopedic surgeries: a randomized trial. Anaesth. pain intensive care 2023;27(4):456−463. DOI: 10.35975/apic.v27i4.2191&#x0D; Received: March 30, 2023; Reviewed: April 22, 2023; Accepted: April 22, 2023

A prospective randomized study to compare hemodynamic changes and post-operative outcome of intravenous buprenorphine versus epidural buprenorphine in patients undergoing abdominal surgeries under general anesthesia

Background: Post-operative pain following major abdominal surgeries is accompanied with multitude of negative consequences, including increased morbidity, impaired physical function, and slow recovery. Opioids are the gold standard of post-operative pain management. Buprenorphine is a new semi-synthetic opioid and 0.3 mg has shown equipotent effect as 12.5 mg of morphine and 0.125 mg of fentanyl. Aims and Objectives: The aims of this study were to compare the effects of epidural and intravenous buprenorphine and clinically significant differences on perioperative hemodynamic variables, duration, and quality of analgesia and its adverse-effects. Materials and Methods: A total of 60 patients with ASA grade I/II scheduled for elective abdominal surgeries under general anesthesia were randomized into two groups. Group IA received intravenous Inj Buprenorphine 0.3 mg diluted with 10 mL of normal saline and 10 mL NS given epidurally just before the closure of peritoneum; Group EA received epidural Inj Buprenorphine 0.3 mg diluted with 10 mL of normal saline and 10 mL NS given intravenously just before the closure of peritoneum. The post-operative hemodynamic vitals, analgesia, and adverse-effects were assessed at certain intervals over 24 h. Results: In both groups, there was a significant reduction in heart rate and blood pressure as compared to baseline (pre-induction) over first 2 h–3 h following the administration. Group EA has shown to provide satisfactory, prolonged duration of analgesia 22.32 h, and better visual analog scale score as compared to Group IA 18.71 h. Conclusion: Epidural buprenorphine 0.3 mg has proved to provide higher satisfactory post-operative analgesia and considered a better alternative to 0.3 mg intravenous buprenorphine in terms of prolonged post-operative analgesia and acceptable adverse event profile.

COMPARISON OF BUPIVACAINE-DEXMEDETOMIDINE VS BUPIVACAINE-FENTANYL VS BUPIVACAINE -SALINE FOR UNILATERAL SPINAL ANAESTHESIA IN LOWER LIMB SURGERY

Introduction: Addition of adjuvants like Dexmedetomidine and Fentanyl to hyperbaric Bupivacaine has been proposed to improve the quality of spinal anaesthesia. Aims and Objectives: The aim of current study was to compare the effects of adding Dexmedetomidine, Fentanyl and saline to low dose hyperbaric Bupivacaine (1 ml, 0.5%) on the properties of unilateral spinal anaesthesia. Methods and Materials: 120 patients divided into three groups. The spinal anaesthetic agent in each of the three groups was 1 mL bupivacaine 0.5% (5 mg). In groups BD, BF and BS, 5mcg of Dexmedetomidine, 25mg of Fentanyl and 0.5 mL saline were added, respectively. The duration of the motor and sensory blocks in both limbs and the assessment of pain during 24 h after surgery were noted. Results: Duration of motor and sensory block were significantly longer in the BF and BD groups than the BS group. Mean total number of rescue analgesic required were less in group BD and BF compared to group BS. Conclusions: Addition of Dexmedetomidine and Fentanyl to low dose Bupivacaine in unilateral spinal anaesthesia increase the duration of the motor, sensory block and post op analgesia.

POST OPERATIVE ANALGESIC EFFECT OF INTRATHECAL FENTANYL AS AN ADJUVANT TO 0.5% HYPERBARIC BUPIVACAINE COMPARED TO 0.5% HYPERBARIC BUPIVACAINE IN SUBARACHNOID BLOCK IN LOWER LIMB ORTHOPAEDIC SURGERIES: AN OBSERVATIONAL STUDY.

Background: Pain is an unkind sensory and sensitive practice associated with actual or potential tissue damage and also is associated with uncomfortable sensations in body. Postoperative pain management holds the key aspect of postoperative care. In this study, we have compared the intrathecal 0.5% hyperbaric bupivacaine with intrathecal fentanyl as adjuvant to 0.5% hyperbaric bupivacaine in terms of safety, efcacy, and postoperative analgesia in patients undergoing lower limb orthopaedic surgeries and also studied the side effects of the drugs used. An Material: analytical, prospective, observational study was conducted in Department of anaesthesia of a tertiary care teaching hospital. All adult patients eligible by the mentioned inclusion and exclusion criteria were considered as sample who were observed and analysed. Total 112 patients were included in the study, which were divided in two equal groups. Group I (BF)- Patients who received 3 ml of 0.5% hyperbaric bupivacaine and 25 μg of fentanyl intrathecally. Group II (B)- Patients who received 3 ml of 0.5% hyperbaric bupivacaine and 0.5 ml of CSF intrathecally. In Results: present study there was no statistical signicant difference in mean age, sex, weight, and ASA grade between two groups. In the study there was statistically signicant difference in mean VAS score between two groups at post op 3rd hrs,4th and 5th hrs. At these intervals mean VAS score was high in group II compared to group I. Mean time of First Rescue Analgesia in group I was 4.85 ± 0.47 hrs and in group II was 3.5 ± 0.53 hrs which highly statistically signicant. There was no statistical signicant difference in side effects amongst the two groups. There was statistically signicant difference in mean HR between two groups at post op 4th and 5th hr. Mean HR was high in group II compared to group I at these two intervals. In the study there was no statistically signicant difference in mean SBP, DBP and MAP between two groups from baseline to post op 6 hrs. Present study concluded that addition of 25 μg fentanyl to intrathecal bupivacai Conclusion: ne offers longer duration of postoperative analgesia. So, it has suggested that fentanyl is a better choice with regards to postoperative analgesia in lower limb orthopaedic surgeries.

Comparison of continuous erector spinae plane block and thoracic paravertebral block for postoperative analgaesia in patients undergoing modified radical mastectomy: A randomised controlled non-inferiority trial.

Modified radical mastectomy (MRM) is associated with significant postoperative pain for which many blocks including thoracic paravertebral (TPV) block are being used. Erector spinae plane (ESP) block is a recently described technique. We planned to compare the efficacy and safety of ultrasound-guided continuous ESP and TPV blocks for postoperative analgaesia following MRM. Sixty-six patients belonging to American Society of Anaesthesiologists physical status I and II, aged 25-85 years, undergoing MRM were enrolled and randomly allocated into two groups. Ipsilateral block was given preoperatively at T3 or T4 level with 20 ml of 0.5% ropivacaine and 50 μg fentanyl. Infusion of 0.5% and 0.2% ropivacaine with fentanyl 2 μg/ml at a rate of 5 ml/hr was continued during intraoperative and postoperative period, respectively. Pain was assessed using visual analogue scale (VAS) till 24 hours. Block performance time, time to first rescue analgaesia, total amount of rescue analgaesic consumed, the incidence of procedure-related and postoperative complications, failure rate and patient satisfaction score were also recorded. Data collected were analysed using the Chi-square test or Student's t-test with the help of SPSS 22.0. Demographics, baseline vitals, VAS scores both at rest and on movement, block performance time, time to first rescue analgaesia, the total amount of rescue analgaesia and patient satisfaction score were comparable in both groups (P value > 0.05). No complications were observed in either group. In patients undergoing MRM, continuous catheter technique ESP block is as efficacious and safe as TPV block for providing prolonged postoperative analgaesia.

Propofol infusion for sedated upper gastrointestinal endoscopic ultrasound: a comparison of propofol alone versus propofol-fentanyl or propofol-midazolam

Background: Gastrointestinal (GI) endoscopic untrasound is the major technique for diagnosis of GI disease and treatment. Various sedation and analgesia regimens such as midazolam, fentanyl, and propofol can be used during GI endoscopy. The purpose of the study was to compare propofol alone and propofol combine with midazolam or fentanyl in moderate sedation for GI endoscopy. Objectives: To observe the efficiency comparison between propofol alone and propofol/fentanyl or propofol/midazolam on sedation during upper gastrointestinal endoscopic ultrasound. Methods: In a prospective, randomized clinical study, 90 patients were assigned to group 1 (n = 30; 1 mg/kg IV propofol) group 2 (n = 30; 1 mg IV midazolam intravenous followed 1 mg/kg IV propofol) or group 3 (n = 30; 50 μg fentanyl followed 1 mg/kg IV propofol). Each patient was administered 1 mg/kg propofol for induction. All of the patients were administered an additional dose of IV propofol infusion (5 mg/kg/h). This study was performed in Hue University of Medicine and Pharmacy Hospital, between January 2020 - 2021. Total propofol consumption, time to achieve, physician and patient satisfaction scores, and instances of side effects, such as bradycardia and hypotension were recorded. Postprocedural records included recovery time, postoperative adverse events (nausea, vomiting, dizziness, recall, and pain) and satisfaction. Results: The average propofol consumption was 283.8 ± 113 mg in Group 1 and 230 ± 76.3 mg in Group 2 and 231.8 ± 76.3 mg in Group 3 (p &lt; 0.05). The incidence of moving motor or verbal) was lower in Group 3 (p &lt; 0.05). The physician satisfaction was higher significantly in Group 3 (p &lt; 0.05). Total propofol consumption was higher in group 1 significantly. Time to onset of sedation was significantly higher in group 1 The physician satisfaction was higher significantly in Group 3. Overall, the other results were similar in 3 groups. Conclusion: Both propofol/fentanyl and propofol/midazolam combinations provided appropriate hypnosis and analgesia during upper gastrointestinal endoscopy. However, propofol consumption was significantly lower and greater endoscopist satisfaction in group using the propofol/ fentanyl combination. Key words: sedation, upper gastrointestinal endoscopy, propofol, fentanyl, midazolam

To Compare Isobaric Thoracic Spinal Anesthesia Versus General Anesthesia in Laparascopy Cholecystectomy

Background: The laparoscopic cholecystectomy procedure is typically carried out under general anesthesia, but regional techniques, such as low thoracic isobaric spinal anesthesia, have been used to manage patients with significant medical problem like coexisting systemic disease, who are deemed to be high risk in general anesthesia. Segmental spinal anesthesia has great outcomes in terms of post-operative discomfort, the need for analgesics, relatively fewer complications, and shorter hospital stays. Thus the aim of this study to avoid and minimize the risk of general anesthesia who does not have any significant comorbidity. So it might be a substitute for a standard laparoscopic cholecystectomy. Material and Methods: Total 60 adult patient with ASA1 &amp; I I, 18-60 years, with normal coagulation profile, is divided into 2 groups. Group IS (Isobaric) - given 2.5 ml of isobaric preservative free bupivacaine 0.5% (levobupivacaine) + 0.5 mg of Fentanyl at T9-T10/T10-T11 into sub arachnoid space. Group GA – given general anesthesia using propofol, fentanyl citrate and atracurium besylate. After intubation, ventilation was controlled and balanced anesthesia was continued with isoflurane. After completion, neuromuscular block was anatagonized neostigmine methylsulfate and glycopyrrolate at the end of surgery. Results: Isobaric spinal anesthesia showed good control in intraoperative as well as postoperative pain control as compared to general anesthesia. In few patients, there were minor degrees of nausea, vomiting, abdominal pain, shoulder pain, patient anxiety or itchng which were treated with standard medication like fentanyl and midazolam. All patients can resume oral intake on the day of surgery. Conclusions: In conclusion, this study provide evidence that segmental spinal anesthesia can be used in place of general anesthesia in healthy individuals also.

Effect of addition of intrathecal preservative free magnesium sulfate with 0.5% bupivacaine heavy and fentanyl with 0.5% bupivacaine heavy on post-operative pain relief in patients undergoing hysterectomy

Background: Spinal anesthesia is the most common neuraxial anesthesia for infraumblical surgeries. The use of various adjuvants has become popular in today’s scenario to enhance its quality. Aims and Objectives: The aim of this study was to evaluate the onset, duration of sensory and motor block, hemodynamic effects (if any), duration of post-operative analgesia, and adverse effects of fentanyl or magnesium given intrathecally with 0.5% bupivacaine heavy in patients undergoing hysterectomy. Materials and Methods: This prospective randomized double-blinded study was conducted in total sixty patients undergoing hysterectomy, divided into two groups of 30 patients each. Group F received 25 μg fentanyl with 3 mL 0.5% bupivacaine heavy and Group M received 100 mg magnesium sulfate with 3 mL 0.5% bupivacaine heavy. The onset and duration of sensory and motor blockade, duration of analgesia, hemodyamics, and side effects were assessed. Results: The mean time of onset of sensory and motor block was less in fentanyl (P&lt;0.001). Duration of sensory, motor block, and duration of analgesia was more in fentanyl group (P&lt;0.001), whereas incidence of side effects such as bradycardia, hypotension, and shivering was less in magnesium. Conclusion: Our study concluded that addition of fentanyl as adjuvant effectively augmented the quality of spinal anesthesia, but magnesium provided stable hemodynamics and lesser side effects as compared to fentanyl.

Dexmedetomidine versus fentanyl effect as adjuvants to bupivacaine on post spinal urinary retention in knee joint arthroscopic surgeries

ABSTRACT Background Ambulatory knee surgeries are increasing in frequency, however post spinal urinary retention can represent a hazardous post-operative issue to patients. The aim of this study was to assess the impact of intrathecally injected 5 µg dexmedetomidine, or 25 µg fentanyl as adjuvants to bupivacaine in low dose spinal anesthesia for unilateral arthroscopic knee surgeries, on the incidence of post-operative urinary retention (POUR), the duration of sensory and motor blocks, time to micturition, and the number of patients who needed an indwelling (Foley’s) catheter. Methods Seventy patients, American Society of Anesthesiologists (ASA) physical status I or II, from 21 to 50 years old, were randomly divided into two equal groups: the Bupivacaine-Dexmedetomidine group (BD) patients and the Bupivacaine-Fentanyl group (BF) patients. Results The incidence of POUR was statistically non-significant less in the BD group patients, than in the BF group patients. The duration of sensory and motor blocks, as well as the time to micturition, was comparable between patients in the two groups. No patient in either group required insertion of an indwelling urinary catheter at the sixth post-operative hour. Conclusion In unilateral arthroscopic knee surgeries, the addition of dexmedetomidine to low-dose spinal anesthesia decreased the clinical incidence of POUR compared to the addition of fentanyl.

Evaluation of paradoxical effect of small dose ketamine as adjuvant in deep sedation for endoscopy patients

ABSTRACT Background This study tested the hypothesis that use of ketamine as an ‎adjuvant to propofol in the induction of deep sedation for ‎endoscopy patients could lead, paradoxically, to faster ‎emergence.‎ Methods We conducted a single-center, prospective randomized ‎controlled study on 154 adult ASA I or II patients‎, admitted for ‎gastrointestinal endoscopies‎. Patients were sedated with 25 µg ‎fentanyl and 1 mg/kg propofol bolus over 30 s. Patients ‎were divided into two groups: Group P (n = 77), sedated with ‎propofol only, and Group PK (n = 77), who received additionally a ‎single dose of ketamine (0.1 mg/kg) at induction. If the patient ‎moved or Ramsay Sedation Score (RSS) regressed to <4, ‎increments of 0.25 mg/kg of propofol were given. After the end ‎of the procedure, emergence from sedation was assessed with ‎modified Aldrete score, 5 and 10 m after admission to the ‎recovery room.‎ Results Adding a small dose of ketamine did not significantly achieve ‎deep sedation (RSS ≥4) more quickly or result in lesser ‎propofol increments. Patients who received ketamine showed a ‎statistically significant improvement in the Modified Aldrete ‎score when recorded 5 min after admission to the recovery ‎room (Group P 8.73 ± 1.02, Group PK 9.1 ± 0.96, P value = ‎‎0.02), but not after 10 min (Group P 9.03 ± 0.74, Group PK ‎‎9.21 ± 0.8, P value = 0.146).‎ Conclusion Inclusion of a small single dose of ketamine in the induction of sedation for gastrointestinal endoscopy significantly improves emergence from sedation.

To evaluate the efficacy of magnesium sulfate and fentanyl as an adjuvant to ropivacaine in supraclavicular brachial plexus block for post-operative pain relief in the upper limb surgeries: A comparative randomized study

Background: Adjuvants to local anesthetics have been used to prolong the duration of analgesia after brachial plexus block surgery. This study evaluates the effects of adding magnesium sulfate and fentanyl with ropivacaine in the supraclavicular brachial plexus block to prolong the duration of analgesia. Aims and Objectives: The aim of the present study was to compare the onset and duration of sensory and motor blockade with the quality of perioperative analgesia and post-operative side effects if any, provided by magnesium sulfate and fentanyl as adjuvants to ropivacaine in supraclavicular block. Materials and Methods: A total of 80 patients with American Society of Anesthesiologists Grade I/II scheduled for elective upper limb surgeries were randomly allocated into two groups. Group M received 30 ml of 0.5% ropivacaine with 250 mg magnesium sulfate and Group F received 30 ml of 0.5% ropivacaine with 50 μg fentanyl for supraclavicular brachial plexus block using PNS guidance. The onset and duration of sensory and motor block, time for the requirement of rescue analgesia, and adverse events during the perioperative period were noted. Results: Onset of sensory block. In group M, the mean onset of sensory blockade was 8.91±1.11 min and in Group F, the mean onset of sensory blockade was 12.12±1.14 min. The mean onset of motor block was 11.57±1.62 min in Group M, and 15.17±1.43 min in Group F. Duration of sensory block is 432.9±38.24 min in Group M and 553.45±39.91 min in Group F, respectively, Duration of motor block in Group M is 392.55±35.22 min and in Group F is 517±44.51 min which was statistically significant. Conclusion: Fentanyl prolonged the duration of sensory and motor block and duration of postoperative analgesia as compared to magnesium sulfate when used as an adjuvant to ropivacaine in supraclavicular brachial plexus block and was not associated with any major adverse events.

Intrathecal Buprenorphine versus Intrathecal Fentanyl as Adjuvants to Hyperbaric Bupivacaine in Spinal Anaesthesia for Lower Segment Caesarean Sections: A Randomised Clinical Study

Introduction: Spinal anaesthesia is the choice technique for Lower Segment Caesarean Section (LSCS). When using subarachnoid block (spinal analgesia), opioids are employed as the main adjuvants along with local anaesthetics to achieve intra/postoperative analgesia. These opioids have desirable properties such as reducing the dose of local anaesthetics, minimising side-effects, providing analgesia, and prolonging the duration of anaesthesia. Aim: To evaluate and compare the efficacy between intrathecal Buprenorphine and Fentanyl as adjuvants to hyperbaric bupivacaine (0.5%) in women undergoing LSCS under spinal anaesthesia. Materials and Methods: A randomised double-blinded clinical trial was conducted at Bharati Vidyapeeth Hospital and Research Centre in Pune, Maharashtra, India between July 2021 and February 2022. A total of 80 parturients with American Society of Anaesthesilogists (ASA) grade II, aged 18 and older, scheduled for elective LSCS, were randomly divided into two groups of 40 each. Group B received 1.8 mL of 0.5% Bupivacaine with 60 μg Buprenorphine, while Group F received 1.8 mL of 0.5% Bupivacaine with 25 μg Fentanyl. The onset/duration of motor block and sensory block, intraoperative haemodynamics, sideeffects, postoperative pain, and demand for the first rescue analgesia were assessed using Chi-square test, Fisher’s-exact probability test, or independent sample t-test. Results: Demographic data such as age, weight, Body Mass Index (BMI), and ASA grade were similar in both groups. The mean duration of surgery in Group B and Group F was 48.12±6.86 min and 48.25±6.56 min, respectively. The mean duration of sensory blockade in Group B was 264.38±37.16 min, and in Group F it was 193.50±34.27 min. The total duration of motor block was 231.00±43.74 minutes in Group B and 171.00±36.87 min in Group F. The total duration of sensory and motor block in Group B was significantly longer (p-value &lt;0.05). The mean time to first rescue analgesia in Group B and Group F was 304.63 min and 228.63 min, respectively (p-value &lt;0.05). Conclusion: The present study concluded that both drugs are safe and suitable as adjuvants with local anaesthetics in spinal anaesthesia for LSCS. The addition of intrathecal buprenorphine to bupivacaine provides a more promising postoperative analgesic effect compared to intrathecal fentanyl, without causing any significant maternal or neonatal side-effects.

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

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

Comparison of dural puncture epidural approach versus conventional epidural approach for anesthesia in patients undergoing total knee arthroplasty: Prospective randomized study

Background: Epidural anesthesia reduces the exposure to other anesthetics and analgesics. The dural puncture epidural (DPE) approach improves caudal spread of analgesia compared with epidural (EPL) approach without the side effects observed with the combined spinal EPL method. The goal of this work was to evaluate the efficacy of DPE method versus standard EPL method as an anesthetic method in cases undergoing Total Knee Arthroplasty (TKA). Methods: This prospective randomized double blinded study was carried out on 70 cases admitted for elective total knee replacement surgery. Cases were subdivided in to two equal groups: group I (EP): received fifeteen millilitres of (0.25% plain bupivacaine and 50 µg fentanyl) over 5 min., there was no dural puncture in this group and group II (DPE): who received fifeteen millilitres of (0.25% plain bupivacaine and 50 µg fentanyl) over 5 min., administered in the epidural space by epidural catheter at L3-L4 interspace, a dural puncture was created. All cases were assessed for time of onset of motor block, duration, number of top-up doses for 24 hours postoperative and adverse events. Results: There was significant decrease in mean value of time till sensory block and time till motor block occurred in group II versus group I (p value <0.001). there was significant decrease in mean value of Breen Modified Bromage scale in group II (p value <0.05) at 5min and 8min versus group I. Intergroup comparison of duration from administration of block till first top up dose and number of top up doses revealed no difference between two approaches. Conclusions: DPE method seemed to have faster onset of sensory and motor block versus standard EPL method.