Mcg Of Fentanyl Research Articles

Comparing the Effectiveness and Safety of Intrathecal Dexmeditomidine and Fentanyl as an Adjuvant to Isobaric Ropivacaine.0.75 % In Lower Abdominal Surgeries: A Study Protocol

Background: Spinal anaesthesia is a form of local anaesthesia, wherein conduction block of nerve roots is done with the aid of injecting a small dose of local anaesthesia into the subarachnoid space via a lumbar puncture in left lateral position in midline at L3 L4 interface. Drug is given after confirming free flow of CSF. Local anaesthetics work for a short duration and adjuvants are used for prolongation of postoperative analgesia. Ropivacaine, a brand new amide local anaesthetic, accepted via FDA IN 1997 and using it extensively in India since 2009. Ropivacaine due to its excessive Pka and decreased lipid solubility has received popularity. This study has been planned to compare the effects of injection Dexmedetomidine & injection Fentanyl as an Adjuvant to Intrathecal isobaric Ropivacaine 0.75% for lower abdominal surgeries.
 Materials and Methods: This will be a Comparative Experimental Prospective Study conducted at Anesthesiology department of AVBRH, Wardha. 80 patients will be randomized into two groups. One group will receive 3 ml of 0.75 percent isobaric ropivacaine with dexmedetomidine 10 mcg (Group RD). Another group will receive 20 mcg of fentanyl (Group RF) intrathecally for lower abdominal surgeries. Data on block characteristics, hemodynamic changes, and side effects will be collected and compared for the two groups.
 Expected Results: Clinically significant results are expected in terms of mean time needed and Mean of total sensory block length in Group RD compared to Group RF.
 Conclusion: Addition of 10μg dose of dexmedetomidine to 3ml of 0.75 percent isobaric ropivacaine produces earlier sensory blockade, prolonged sensory and motor blockade and improved sedation and post-operative analgesia.

Laparoscopic Cholecystectomy under Segmental Thoracic Spinal Anesthesia

Introduction: Cholelithiasis or gallstones are hardened deposits of digestive fluid that can form in gallbladder. The treatment of gallstones depends upon the stage of disease. Once gallstones become symptomatic, definitive surgical intervention with cholecystectomy is usually indicated (typically, laparoscopic cholecystectomy is the first-line therapy). Laparoscopic cholecystectomy removes the gallbladder and gallstones through several small incisions in the abdomen. This case report aims to discuss the managent of segmental thoracic spinal anesthesia in laparoscopic cholecystectomy.
 Case: We report on the cases of 2 patients who undego elective laparoscopic cholecystectomy. Female, 53 years old, will undergo laparoscopic cholecystectomy, performed anesthesia with segmental thoracic spinal anesthesiatechnique using the anesthetic agent 3 ml of Levobupivacaine 0,5% + 25 mcg of Fentanyl, requiring a sensory block to at least T10-T11 dermatom. Patients received a 1,2 mcg target control infusion (TCI) propofol intravenous is administered as intermittent boluses to achieve deep sedation. The operation lasts 1 hour, with a bleeding 15 cc and urine output 100 cc, hemodynamically stable. Female, 42 years old, will undergo laparoscopic cholecystectomy, performed anesthesia with segmental thoracic spinal anesthesia technique using the anesthetic agent 3 ml of Levobupivacaine 0,5% + 25 mcg of Fentanyl, requiring a sensory block to at least T10-T11 dermatom. Patients received a 3 mg of midazolam intravenous is administered as intermittent boluses to achieve deep sedation. The operation lasts 1 hour, with a bleeding 15 cc and urine output 150 cc, hemodynamically stable. The level and duration of sensory block, intensity and duration of motor block were recorded. A 20 % or more decrease in MAP compared to baseline was considered as hypotension, iv ephedrine 5 mgr bolus administreted.
 Conclusion: Laparoscopy is a surgical procedure that uses minimally invasive surgical techniques (minimally invasive surgery) where the doctor uses a small telescope / camera that is inserted into the stomach and surgical instruments in mini form. This procedure has many advantages because it is not invasive, the amount of bleeding can be reduced, postoperative pain can be minimized. Regional anesthesia procedure in laparoscopic cholecystectomy based on several studies and case reports can be performed and is a safe procedure.

Comparative Study Between Bupivacaine 0.5% Versus Bupivacaine 0.5% with Fentanyl in TAP Block for Post-Operative Analgesia After Appendectomy

Abstract Background Post operative pain and stress is a very known complication of many surgical procedures which represents a burden for the patient and associated with many complications including stress, myocardial ischemia, prolonged hospital stay and the need of extensive post operative analgesia. Objective to compare the effectiveness of US guided TAP block using 0.5% bupivacaine versus 0.5% bupivacaine with Fentanyl for postoperative analgesia in patients undergoing appendectomy. Patients and Methods After ethical committee approval and informed consent from the patients, this prospective randomized control study, randomization done by closed envelope method & was performed on total 60 patients who underwent surgical appendectomy in Ain Shams University hospitals for 3 months from January to March 2019. Results In our study, 60 patients were randomly divided into 2 equal groups. Control group received bupivacaine only while the fentanyl group in which 50 ug of fentanyl were added to bupivacaine. All patients received equal volumes. Our study showed that addition of a 50 microgram of fentanyl to bupivacaine in ultrasound-guided TAP block has statistically significant effect on the onset of sensory block and prolonged the duration of the sensory block. In addition, fentanyl prolonged the duration of analgesia significantly, as proved by the time of request of first analgesia. Moreover, in fentanyl group, postoperative analgesic requirements were greatly lesser than that of bupivacaine groups. Addition of fentanyl also did not affect the hemodynamics to a significant level. This makes fentanyl with bupivacaine more superior than the use of bupivacaine alone. Conclusion Fentanyl as an adjuvant to bupivacaine in Ultra-sound guided TAP block reduced post-operative pain scores, porolonged the duration of analgesia and decreased demand for rescue analgesics.

Combined Spinal Epidural Anaesthesia Technique with Ketamine Infusion for Emergency Laparotomy of a Known COVID-19 Case at High Altitude of 12000 Feet Above Mean Sea Level

SARS-CoV-2 is a highly infectious virus known to cause severe acute respiratory syndrome in humans known as COVID-19. It is well established that the mode of transmission is through aerosol generation. Since the invasive procedures like endotracheal intubation place the anaesthesiologist and the operating room staff highly exposed to the risk of infection it is prudent to follow regional anaesthesia technique wherever possible. The present case is of a 34-year-old COVID 19 positive male patient who underwent emergency laparotomy in a service hospital of armed forces at 12000 feet above sea level under combined spinal and epidural anaesthesia supplemented with sedation using intravenous infusion of Ketamine. After the attachment of standard ASA monitor and taking in account of baseline readings patient was administered an 18-gauge epidural secured in the T12-L1 level with the catheter was fix at 12 cm on the skin. Sub arachnoid block was administered to the patient using 2.75 ml of 0.5 % Bupivacaine (heavy) and 25 mcg of Fentanyl in L2-L3 space using a 26-gauge spinal needle in sitting position. Once the height of the block was ascertained at T6 level by loss of temperature sensation the surgery commenced. Patient was administered with 3.0 mg of Morphine in epidural space for perioperative analgesia. For allaying intraoperative discomfort patient was sedation infusion of Ketamine of 0.6mg/kg/hr to keep the Ramsay sedation score between 3-4. The intraoperative period was uneventful, and the patient did not require any supplemental analgesia during the surgery. Post operatively the patient was pain free and comfortable with no features of hypopnea, post-operative nausea vomiting and shivering and was shifted to the post-operative care unit in the covid facility of the hospital.

Laparoscopic Cholecystectomy under Segmental Thoracic Spinal Anesthesia

Introduction: Cholelithiasis or gallstones are hardened deposits of digestive fluid that can form in gallbladder. The treatment of gallstones depends upon the stage of disease. Once gallstones become symptomatic, definitive surgical intervention with cholecystectomy is usually indicated (typically, laparoscopic cholecystectomy is the first-line therapy). Laparoscopic cholecystectomy removes the gallbladder and gallstones through several small incisions in the abdomen. This case report aims to discuss the managent of segmental thoracic spinal anesthesia in laparoscopic cholecystectomy.
 Case: We report on the cases of 2 patients who undego elective laparoscopic cholecystectomy. Female, 53 years old, will undergo laparoscopic cholecystectomy, performed anesthesia with segmental thoracic spinal anesthesia technique using the anesthetic agent 3 ml of Levobupivacaine 0,5% + 25 mcg of Fentanyl, requiring a sensory block to at least T10-T11 dermatom. Patients received a 1,2 mcg target control infusion (TCI) propofol intravenous is administered as intermittent boluses to achieve deep sedation. The operation lasts 1 hour, with a bleeding 15 cc and urine output 100 cc, hemodynamically stable. Female, 42 years old, will undergo laparoscopic cholecystectomy, performed anesthesia with segmental thoracic spinal anesthesia technique using the anesthetic agent 3 ml of Levobupivacaine 0,5% + 25 mcg of Fentanyl, requiring a sensory block to at least T10-T11 dermatom. Patients received a 3 mg of midazolam intravenous is administered as intermittent boluses to achieve deep sedation. The operation lasts 1 hour, with a bleeding 15 cc and urine output 150 cc, hemodynamically stable. The level and duration of sensory block, intensity and duration of motor block were recorded. A 20 % or more decrease in MAP compared to baseline was considered as hypotension, iv ephedrine 5 mgr bolus administreted.
 Conclusion: Laparoscopy is a surgical procedure that uses minimally invasive surgical techniques (minimally invasive surgery) where the doctor uses a small telescope / camera that is inserted into the stomach and surgical instruments in mini form. This procedure has many advantages because it is not invasive, the amount of bleeding can be reduced, postoperative pain can be minimized. Regional anesthesia procedure in laparoscopic cholecystectomy based on several studies and case reports can be performed and is a safe procedure.

Laparoscopic Cholecystectomy under Segmental Thoracic Spinal Anesthesia

Introduction: Cholelithiasis or gallstones are hardened deposits of digestive fluid that can form in gallbladder. The treatment of gallstones depends upon the stage of disease. Once gallstones become symptomatic, definitive surgical intervention with cholecystectomy is usually indicated (typically, laparoscopic cholecystectomy is the first-line therapy). Laparoscopic cholecystectomy removes the gallbladder and gallstones through several small incisions in the abdomen. This case report aims to discuss the managent of segmental thoracic spinal anesthesia in laparoscopic cholecystectomy.
 Case: We report on the cases of 2 patients who undego elective laparoscopic cholecystectomy. Female, 53 years old, will undergo laparoscopic cholecystectomy, performed anesthesia with segmental thoracic spinal anesthesia technique using the anesthetic agent 3 ml of Levobupivacaine 0,5% + 25 mcg of Fentanyl, requiring a sensory block to at least T10-T11 dermatom. Patients received a 1,2 mcg target control infusion (TCI) propofol intravenous is administered as intermittent boluses to achieve deep sedation. The operation lasts 1 hour, with a bleeding 15 cc and urine output 100 cc, hemodynamically stable. Female, 42 years old, will undergo laparoscopic cholecystectomy, performed anesthesia with segmental thoracic spinal anesthesia technique using the anesthetic agent 3 ml of Levobupivacaine 0,5% + 25 mcg of Fentanyl, requiring a sensory block to at least T10-T11 dermatom. Patients received a 3 mg of midazolam intravenous is administered as intermittent boluses to achieve deep sedation. The operation lasts 1 hour, with a bleeding 15 cc and urine output 150 cc, hemodynamically stable. The level and duration of sensory block, intensity and duration of motor block were recorded. A 20 % or more decrease in MAP compared to baseline was considered as hypotension, iv ephedrine 5 mgr bolus administreted.
 Conclusion: Laparoscopy is a surgical procedure that uses minimally invasive surgical techniques (minimally invasive surgery) where the doctor uses a small telescope / camera that is inserted into the stomach and surgical instruments in mini form. This procedure has many advantages because it is not invasive, the amount of bleeding can be reduced, postoperative pain can be minimized. Regional anesthesia procedure in laparoscopic cholecystectomy based on several studies and case reports can be performed and is a safe procedure.

Comparative Study of the Analgesic Efficacy of Intrathecal Fentanyl with Ultrasound-Guided Transversus Abdominis Plane Block after Lower Segment Cesarean Section.

Background:This study was conducted to compare the analgesic efficacy of intrathecal fentanyl with ultrasound-guided transversus abdominis plane (TAP) block after lower segment cesarean section. The objectives of the study were to compare the effects of subarachnoid fentanyl versus TAP block with respect to duration of postoperative analgesia, time for first analgesic request, total analgesic consumption in 24 h, time to first breastfeed and Apgar score at 1 and 5 min.Materials and Methods:Sixty-two patients undergoing elective or emergency cesarean delivery were recruited for the study in a prospective, randomized, single-blind manner. The patients were randomly allocated to either intrathecal fentanyl group (Group F) or TAP block group (Group T) after determining the eligibility criteria. Group F patients received subarachnoid block with 10 mg of 0.5% bupivacaine heavy with 25 mcg of fentanyl. Group T patients received subarachnoid block with 10 mg of 0.5% bupivacaine heavy prior to surgery and at the end of surgery, they received TAP block with 0.25% bupivacaine 20 mL on each side.Results:Group T had significantly longer time for the first analgesic request (7.65 ± 1.23 h) than group F (4.10 ± 0.32 h). The total analgesic consumption in 24 h was significantly less in Group T (1.0 ± 0) than Group F (2.13 ± 0.34). The Visual Analogue Scale scores at rest and on movement were significantly less in Group T than Group F at all-time points. The Apgar score at 1 and 5 min and time to first breast feed were comparable between the two groups. The incidence of side effects was less in Group T.Conclusion:This study indicated that ultrasound-guided TAP block has a better analgesic as well as safety profile compared to intrathecal fentanyl for cesarean delivery.

DIPHENHYDRAMINE AS ADJUNCTIVE THERAPY DURING MODERATE SEDATION FOR ENDOBRONCHIAL ULTRASOUND

SESSION TITLE: Procedures Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Endobronchial ultrasound (EBUS) and real-time guidance of transbronchial needle aspiration (TBNA) has become a widely adopted tool in evaluation of intrathoracic lymphadenopathy for malignant or non-malignant disease. EBUS has been shown to have comparable diagnostic yield and safety profile when done with either moderate sedation (MS) or deep sedation (DS). The purpose of this study was to assess the use of diphenhydramine in bronchoscopies and specifically EBUS/TBNA. METHODS: Patient data was collected via chart review of all bronchoscopies done at the Kansas City VA Medical Center between July 2018 and June 2019. Only procedures done under MS were included. Sedation medications used were fentanyl and midazolam. The use of intravenous diphenhydramine, dose and timing was at the discretion of the proceduralist. RESULTS: A total of 165 bronchoscopies were performed under MS; 84 were EBUS procedures. Of the EBUS patients, 81 (96.4%) patients were male; mean age was 66.4±10.7. No patients had a documented history of chronic opioid use.Midazolam and fentanyl were used for induction and maintenance of sedation in all EBUS patients. The mean doses were 5.3±3.3 mg of midazolam and 203.9±52.1 mcg of fentanyl. Diphenhydramine was used in 62 (73.8%) of EBUS procedures. Twenty (32.3%) patients received diphenhydramine at induction compared to 42 (67.7%) who only received it during the procedure. The mean dose of diphenhydramine was 41.5±12.7 mg.Comparing EBUS in which any diphenhydramine was used to cases in which it was not, there was no significant difference in the cumulative doses of midazolam (5.6±3.5 vs. 4.5±2.5mg, p=0.161) and fentanyl (204.8±57.6 vs. 201.1±33.2mcg, p= 0.777). The time to adequate sedation was significantly higher in patients who received diphenhydramine (11.1±4.9 vs. 8.6±2.9 min, p=0.006). Procedure time (64.0±25.1 vs 61.4±20.2 min, p=0.660) and recovery time (81.4±32.4 vs. 81.3±47.9 min, p=0.995) were not significantly different.Compared to no use at all, any diphenhydramine use (at induction or during the procedure) was associated with a lower fentanyl dose per minute (4.2±2.6 vs. 7.2±5.0 mcg/min, p<0.001) and a trend towards a lower midazolam dose per minute although not statistically significant (0.1±0.1 vs. 0.2±0.6 mg/min, p=0.271). CONCLUSIONS: Use of diphenhydramine in our cohort was associated with a mean of 3.0 mcg/min lower fentanyl dose, equivalent to an average fentanyl dose reduction of 193mcg per procedure. Further randomized controlled trials with a protocol for sedation including diphenhydramine or placebo would be the next endeavor to fully evaluate this hypothesis. CLINICAL IMPLICATIONS: Diphenhydramine appears to reduce fentanyl requirements and therefore should be considered as adjuctive therapy for moderate sedation in EBUS procedures. DISCLOSURES: No relevant relationships by Abdallah Abboud, source=Web Response No relevant relationships by Sonia Castillo, source=Web Response

Postoperative Single-shot Epidural Fentanyl and Bupivacaine for Postoperative Analgesia After Lumbar Decompression: A Prospective, Double-blind Randomized Study.

Randomized clinical trial. To evaluate the efficacy of the postoperative single-shot bolus of epidural Fentanyl and Bupivicaine in providing pain relief postlumbar decompression surgery. Despite lumbar decompression's success in alleviating symptoms of sciatica, radiculopathy, and neurogenic claudication, transient back and buttock pain has been a common complaint postoperatively. Providing good postoperative pain alleviation predicts patient's quality of recovery. We performed a randomized, double-blinded, clinical trial. Forty-five patients scheduled for lumbar decompression for a year's period who were randomly assigned to receive a postoperative bolus of 10-mL solution of 50 mcg of Fentanyl, 0.125% Bupivacaine, and 0.9% saline solution via an intraoperatively placed epidural catheter immediately after wound closure, before dressing application. Facial pain scale scores (from 0 to 10) were measured at three time points after surgery (fully awake at recovery room, transfer to ward, first postoperative day). Postoperative need for oral analgesics, time to independent ambulation, associated adverse events, and time to hospital discharge were also evaluated. Pain scores were noted to be significantly lower at all time points in the epidural group (P < 0.001). In turn, they also received less on-demand oral pain medications than those in the control group (P = 0.000). The mean time to ambulation was 0.09 days in the epidural group and 0.91 days in the decompression-alone group (P = 0.000). Criteria for hospital discharge were usually met on Day 0 in the epidural and Day 1 in the control group (P = 0.000). Within the study period, only one infection was noted in the epidural group which necessitated additional lumbar spine surgery (4.3%). No adverse events or complications related to Fentanyl use were observed. A postoperative bolus of Fentanyl and Bupivacaine is effective in reducing early postoperative pain without the related complications of opiod administration. 2.

Comparative study between Fentanyl with (Lidocaine and Bupivicaine) Versus (Lidocaine and Bupivicaine) alone in Supraclavicular Brachial Plexus Block in Upper Limb Surgeries

Abstract Background Post operative pain and stress is a very known complication of many surgical procedures which represents a burden for the patient and associated with many complications including stress, myocardial ischemia, prolonged hospital stay and the need of extensive post operative analgesia. Aim of the Work to study the effect of Fentanyl as an adjuvant to bupivacaine and Lidocaine in supraclavicular brachial plexus block. After taking approval from Local Ethical Committee approval and informed written consent from each patient, this randomized prospective comparative study was conducted on 60 patients who were divided into two groups: Group A (Control group): 20 ml of 0.5% bupivacaine + 6 ml of lidocaine hydrochloride 2% + 1 ml of Normal Saline 0.9%. Group B (Fentanyl group): 20 ml of 0.5% bupivacaine + 6 ml of lidocaine hydrochloride 2% + 1ml of fentanyl 50 ug/ml. Results our study showed that addition of a 50 microgram of fentanyl to bupivacaine and lidocaine in ultrasound-guided supraclavicular nerve block has statistically significant effect on the onset of sensory and motor block and prolonged the duration of the sensory and the motor block. In addition, fentanyl prolonged the duration of analgesia of the plexus block significantly, as proved by the time of request of first analgesia. Moreover, in fentanyl group, postoperative analgesic requirements were greatly lesser than that of bupivacaine and lidocaine groups. Addition of fentanyl also did not affect the hemodynamic to a significant level Conclusion fentanyl with bupivacaine and lidocaine more superior than the use of bupivacaine and lidocaine alone.

COMPARISON OF CLONIDINE AND FENTANYL AS AN ADJUVANT TO INTRATHECAL 0.5% HYPERBARIC BUPIVACAINE IN PATIENTS UNDERGOING KNEE ARTHROPLASTY

Background and Objective: Fentanyl and clonidine as adjuvants are commonly mixed with 0.5% bupivacaine heavy, by intrathecal route, for prolonging both sensory and motor blockade as well as for enhancing postoperative analgesia in patients undergoing major abdominal or lower limb surgery. This study was undertaken to compare the intraoperative effects and postoperative analgesia of fentanyl and clonidine, used as adjuvant to intrathecal bupivacaine during knee arthroplasty.&#x0D; Methodology: This prospective, randomized study was conducted on 60 patients of ASA grade I or II, between 20 and 50 years of age divided into two groups of 30 each. The patients were given 3 ml of 0.5% hyperbaric bupivacaine with either 25 mcg of fentanyl (Group F) or 50 mcg of clonidine (Group C) intrathecally. The onset of sensory and motor block, the duration of blockade, hemodynamic parameters, sedation score, total postoperative analgesia time, and side effects if any were recorded.&#x0D; Results: Both the groups were statistically comparable for demographic data, onset of sensory and motor blockade, duration of blockade and hemodynamic parameters. However, the sedation score was more in clonidine group. The duration of analgesia was significantly prolonged in clonidine group when compared with fentanyl group.&#x0D; Conclusion: In comparison to fentanyl, addition of clonidine to intrathecal bupivacaine prolongs the duration of postoperative analgesia and cause a higher sedation score.&#x0D; Key words: Bupivacaine, clonidine, fentanyl

Incidence and severity of pruritus in pregnant women undergoing lower-segment cesarean section under spinal anesthesia with fentanyl and bupivacaine

Background: Regional anesthesia and analgesia are being widely used nowadays, especially for lower-segment cesarean section (LSCS). However, according to some studies, as well as our observation, there is a high incidence of pruritus among patients undergoing LSCS under regional technique as compared to nonpregnant female patients. To enhance the quality of analgesia and increase the duration of spinal anesthesia, fentanyl is often added as an adjuvant drug. Till date, only few studies have reported the incidence of pruritus among this group after spinal anesthesia with added fentanyl, but none compared it to nonpregnant patients. Aim and Objective: The primary aim of this study was to estimate the magnitude of pruritus after intrathecal fentanyl in parturient patients. The secondary objective was to establish other pathophysiological mechanisms such as patient's body habitus and sex of the baby, which might influence the incidence and severity in this population as compared to nonpregnant patients. Materials and Methods: One hundred and sixty American Society of Anesthesiologists I and II female patients aged between 18 and 45 years were divided into two equal groups. Pregnant women group underwent LSCS, while nonpregnant patients had lower limb orthopedic surgery. Spinal anesthesia was administered using 20 mcg of fentanyl with 2.5 ml of 0.5% bupivacaine. Frequency and severity of pruritus were recorded in the patients of either group. Statistical analysis of the data was done using Chi-square test and logistic regression using SPSS version 22. A P 0.05). Conclusions: Pregnancy is not only a risk factor for pruritus after intrathecal fentanyl but is also responsible for increasing the severity of pruritus.

COMPARATIVE STUDY BETWEEN DEXMEDETOMIDINE AND FENTANYL AS AN ADJUVANT TO BUPIVACAINE IN ULTRASOUND-GUIDED INTERSCALENE BRACHIAL PLEXUS BLOCK IN ARTHROSCOPIC SHOULDER SURGERIES

Background: Poorly controlled acute pain after shoulder surgery is associated with a variety of unwanted post-operativeconsequences, including patient suffering, prolonged hospital stays and an increased likelihood of chronic pain. The interscalene block is the gold standard for shoulder anesthesia and the most commonly used block for shoulder procedures. Aim of the work: to compare the effects of adding either 100 micro-grams of dexmedetomidine or 50 micro-grams of fentanyl to bupivacaine in ultrasound-guided interscalene nerve block, as regards the onset and the duration of the sensory and motor block, and the duration of post-operative analgesia. Patients M Group C: 25 patients received a total volume of 30 ml bupivacaine 0.5%. Group D: 25 patients received a total volume of 30 mlbupivacaine 0.5% added to 100 micrograms of dexmedetomidine, Group F: 25 patients received a total volume of 30 ml bupivacaine 0.5% added to 50 micrograms of fentanyl. Results: This study showed that addition of a 100 micro gram ofdexmedetomidine to bupivacaine in interscalene nerve block shortens the onset times of sensory and motor block and prolongs their duration in comparison to 50 micro-gram of fentanyl when added to bupivacaine, and to bupivacaine when used alone, also dexmedetomidine got and added effect of conscious sedation with minimal side effect. Conclusions: Our study showed that addition of dexmedetomidine to bupivacaine in interscalene nerve block shortened the onset times ofboth sensory and motor blocks and prolonged their durations. This occurred in comparison to fentanyl when added to bupivacaine and to bupivacaine when used alone.

Safety and feasibility of subarachnoid block in laparoscopic cholecystectomy

Background and objectives: Laparoscopic surgery is normally performed under general anesthesia (GA), but regional techniques like epidural or subarachnoid block (SAB) have been found beneficial in patients having associated major medical problems. In selected cases, it can be a safe alternative to GA. Hence, the present study was conducted to explore the safety and feasibility of SAB in otherwise healthy individuals undergoing laparoscopic cholecystectomy.&#x0D; Methods: Forty patients undergoing elective laparoscopic cholecystectomy and fulfilling specific inclusion criteria were included in the study. All patients received a segmental (L2-L3 injection) SAB with 3 ml (0.5%) of bupivacaine and 25 microgram of fentanyl. Laparoscopic cholecystectomy was done by standard 4 port technique. Intra-abdominal pressure was kept low at 9-10 mm Hg using CO2 pneumoperitoneum. Patients were followed up at 30 minutes, 4 hours, at the time of discharge and on day 7 after operation. Any unwanted voluntary or involuntary movement or exaggerated diaphragmatic excursion during the operation was monitored. Operation time, operating room (OR) occupancy time, hospital stay, post-operative pain, analgesic requirement, nausea, vomiting, headache, right shoulder pain, wound-related complications and patient satisfaction were recorded.&#x0D; Results: SAB was effective for surgery in all 40 patients. Two patients required conversion to general anesthesia for persisting low oxygen saturation. Hypotension was recorded in 23.7% patients while 10.5% experienced right shoulder pain. Average operating time was 37.3 minutes (21 - 77 minutes). Awkward movement and exaggerated respiratory excursion was noted in 23.7% and 18.4% cases respectively. Only two cases had to undergo (conversion to) GA. Mean period of hospital stay was 29.3 hours. No incidence of any major complication occurred.&#x0D; Conclusion: This study showed that SAB could be used successfully and effectively for laparoscopic cholecystectomy in healthy patients and may be a safe alternative to GA.&#x0D; IMC J Med Sci 2019; 13(1): 006

How Low Can We Go? A Double-Blinded Randomized Controlled Trial to Compare Bupivacaine 5 mg and Bupivacaine 7.5 mg for Spinal Anesthesia in Cesarean Delivery in Indonesian Population.

BackgroundMaternal hypotension in cesarean delivery related to spinal anesthesia results in increasing morbidity of both mothers and children. Studies show that low dose spinal anesthesia was able to prevent hypotension while providing adequate analgesia. However, the dose used in those studies varies and this leaves the debate of the dose scheme of spinal anesthesia open.ObjectivesThis study aimed to compare the effectiveness of 5 mg hyperbaric bupivacaine 0.5% and 25 mcg of fentanyl with 7.5 mg hyperbaric bupivacaine 0.5% and 25 mcg of fentanyl to prevent hypotension in spinal anesthesia for cesarean delivery.MethodsThis study was a double-blinded randomized controlled trial of 112 mothers undergoing cesarean delivery with spinal anesthesia. The intervention group received 5 mg bupivacaine and 25 mcg fentanyl. The comparison group received of 7.5 mg bupivacaine and 25 mcg fentanyl. The primary outcome was the incidence of hypotension. The adequacy of anesthesia, duration of recovery from the motoric block, the quality of analgesia as perceived by patients and surgeons, and the side effects of anesthesia were also recorded. ResultsThere was no difference of effectiveness to prevent hypotension in both groups. The 7.5 mg dose provided better adequacy of anesthesia as reflected in lower incidence of conversion into general anesthesia. More surgeons reported adequacy of relaxation in the 7.5 mg dose. The 5 mg dose offered faster motoric recovery and fewer side effects.ConclusionsThe dose of 7.5 mg hyperbaric bupivacaine 0.5% and 25 mcg of fentanyl can be used as a prevention measure against hypotension due to spinal anesthesia cesarean delivery.

A comparison of intrathecal dexmedetomidine and fentanyl as an adjuvant to isobaric levobupivacaine for lower limb orthopaedic surgery

Introduction: Levobupivacaine is cardiostable. Fentanyl and dexmedetomidine as adjuvant to improve quality of block. Aim: To compare the efficacy and safety of 25 mcg of fentanyl vs 5 mcg dexmedetomidine as an adjuvant in 0.5% of 3ml of isobaric levobupivacaine in lower limb orthopaedic surgery. Objectives: Onset and duration of sensory block, maximum sensory block. Onset and duration of motor block, maximum motor block, time to regress sensory and motor block, postoperative analgesia. Level of sedation, hemodynamic changes, side effects. Materials and Methods Group A: 0.5% isobaric levobupivacaine 3ml +0.5 ml of NS =3.5ml. Group F: 0.5% isobaric levobupivacaine 3ml+25 mcg fentanyl diluted with NS =3.5ml. Group D: 0.5% isobaric levobupivacaine 3ml + 5 mcg dexmedetomidine diluted with NS =3.5ml. Subarachnoid block were achieved in L3-L4 interspaces. Parameters like pulse, SBP, DBP, MAP, SPO2, RR, level of sensory block, grade of motor block, sedation scale were recorded every min for 5 min, every 5 min till 30 min, every 15 min till 2 hr, every 30 min till end of surgery Intraoperatively side effects were recorded and treated. In postoperative period total analgesic, antiemetic requirement, sedation scale checked. Result: onset of sensory block was earlier in group F. maximum sensory block was in group D. Motor block regress faster in group A. postoperative analgesia was more in group D and side effects were less. Conclusion: Dexmedetomidine group has longer onset of and duration of sensory block and effective postoperative analgesia and fewer side effect as compared to fentanyl group. Keywords: Subarachanoid block, Levobupivacaine.

Incidence of hypotension between Intrathecal Hyperbaric Bupivacaine with and without Fentanyl in Geriatric Patients Undergoing Urological Surgeries

Objective: We aimed to assess the efficacy, the incidence of hypotension and adverse consequences of using intrathecal hyperbaric bupivacaine in comparison to a combination of low dose hyperbaric bupivacaine and fentanyl, in geriatric patients undergoing urological surgeries.Material and Methods: Our study was a prospective, triple-blinded and randomized controlled. One hundred and fortyeight geriatric participants scheduled for urological surgeries were randomly assigned into two groups: Group B (n=74) received intrathecal injection with 0.5% hyperbaric bupivacaine 1.5 milliliters (ml) alone (7.5 milligrams; mg), while Group F (n=74) received 0.5% hyperbaric bupivacaine 1 ml (5 mg) plus 0.5 ml of fentanyl (25 micrograms; mcg) making up to a total volume of 1.5 ml.Results: One hundred and forty-eight patients were included however, six patients were excluded from statistical analysis, due to an inadequate level of anesthesia; hence, 142 patients were analyzed. The incidence of hypotension in group B was: 9.7%, and in group F the percentage was 12.9%, respectively (p-value=0.74). There was no significant difference in regards to the highest sensory level in both groups. The anesthesia level in group B was Thoracic level 11 (T10-T12), and in group F it was 11 (T10-T12) (p-value=0.68), while the analgesia level in group B was Thoracic level 7 (T6-T8) with group F being a Thoracic level 6 (T6-T8) (p-value=0.16). The occurrence of bradycardia, and respiratory depression did not differ between the 2 groups.Conclusion: Intrathecal administration of 5 mg of 0.5% hyperbaric bupivacaine, plus 25 mcg of fentanyl provided an adequate level of sensory blockade, but did not decrease the frequency of hypotension.

Low dose spinal anaesthesia and transversus abdominis plane block in a parturient with peripartum cardiomyopathy for caesarean section following a bloody epidural tap

Peripartum cardiomyopathy (PPCM) is a form of dilated cardiomyopathy which presents unique challenges for anaesthetic management. Here we present a case of PPCM who was given low dose spinal anaesthesia with TAP block for caesarean section which is rarely reported. A 33-year-old multigravida, 35 weeks gestation presented with PPCM with ejection fraction of 24%. Elective caesarean section was planned in view of worsening dyspnoea despite treatment. Graded epidural anaesthesia with invasive monitoring was planned but we encountered a bloody tap whilst securing the epidural catheter, hence switched to low dose spinal anaesthesia (6mg of 0.5% bupivacaine+10mcg of fentanyl). Ultrasound guided bilateral TAP block was given for post-operative analgesia. We observed that the patient had a comfortable and haemodynamically stable experience intra and post operatively. Hence a low dose spinal anaesthesia and TAP block with invasive monitoring can be opted as an anaesthetic technique in PPCM.

Effects of 0.5% heavy bupivacaine at room versus body temperature on shivering and analgesia after spinal anesthesia in patients undergoing cesarean section

Background: Shivering is an undesirable, unpleasant experience after spinal anesthesia. Injecting cold bupivacaine has been incriminated as a contributory factor. Aims and Objective: In this prospective study we evaluated the efficacy of warming the heavy bupivacaine to body temperature for prevention of shivering and if it influences analgesic quality of spinal anesthesia. Materials and Methods: In this double blind, randomized controlled study, 100 patients aged 20-35 years of American Society of Anesthesiologist physical status I and II undergoing elective or emergency Caesarean sections were included and allocated to either Room temperature group (RT Group, n= 50), or Body temperature group (BT group, n = 50). A standard spinal anesthetic of 2ml of 0.5 % heavy bupivacaine plus 20 microgram of fentanyl was administered using 25G pencil point spinal needle in the sitting position. Besides the incidence and intensity of shivering and effect on intraoperative analgesia, effect on hemodynamics, nausea, vomiting, blood loss, pruritis and Apgar scores were recorded. Data was analyzed using SPSS (The Statistical Package for Social Sciences) version 22.0 software (International Business Machines Corporation, Armonk, New York, USA). P < 0.05 was considered significant. Results: The patients were comparable in terms of demographic variables. Shivering was present in 31 (62%) and 7 (14%) patients respectively in RT and BT Groups, which was statistically significant (P = 0.0001). Intensity of shivering ≥3 was observed in 15 (30%) patients of RT group and 5 (10%) patient in BT group. We did not note any difference in the analgesic status intraoperatively nor any difference in the duration of analgesia. Surprisingly, the incidence of pruritis was significantly reduced in the BT group as compared to RT group (P = 0.037). Conclusions: Warming the heavy bupivacaine to body temperature is effective in preventing shivering and reducing pruritis secondary to spinal anesthesia without affecting analgesia.

The Analgesic Efficacy of Transverse Abdominis Plane Block versus Epidural Block after Caesarean Delivery: Which One Is Effective? TAP Block? Epidural Block?

Introduction and Objective TAP block has gained popularity to provide postoperative analgesia after abdominal surgery but its advantage over epidural analgesia is disputed. For lower abdominal surgeries, epidural analgesia has been the gold standard and time-tested technique for providing postoperative analgesia, but contraindications for the same would warrant need for other equally good analgesic techniques. The objective of this study is to compare the analgesic efficacy of both the techniques. Materials and Methods Eighty patients in the ASA I-II risk group, undergone an elective C-section, were randomly assigned to the study. In the TAP group, before the C-section, a single-dose spinal anaesthesia was performed by administering 3 ml of 0.5% hyperbaric bupivacaine to the patients when they were in the sitting position. After the C-section, an ultrasound-guided bilateral TAP block was performed in these patients in the recovery room for postoperative analgesia. In the single-dose EPI group, the patients received 16 cc of isobaric bupivacaine, 3 mg of morphine, and 50 mcg of fentanyl, making a total volume of 20 cc and being administered to the epidural space. Results A higher level of patient satisfaction was observed in the EPI group (p=0.003). The amount (mg) of total analgesics received by the patients in the first 24 hours of the postoperative period was statistically significantly higher (p=0.021) in the TAP group compared to the EPI group. The visual analogue scale (VAS) scores of the EPI group were significantly lower compared to that of the TAP group (p < 0.001). Conclusion The epidural anaesthesia is still the golden standard to achieve a postcaesarean analgesia. Epidural anaesthesia is a considerably effective method in controlling the postoperative pain. We are of the opinion that epidural anaesthesia should be preferred in the first place to achieve a successful postcaesarean analgesia as it provides more effective pain control.