Mixture Of Bupivacaine Research Articles

Comparison of motor blockade, sensory blockade and duration of analgesia between dexmedotomidine and dexamethasone as an adjuvant to bupivacaine in axillary block

Introduction: Axillary block with Bupivacaine mixed with adjuvants like dexmedetomidine, a more selectivealpha2 adrenoreceptor agonist, induces faster onset of blockade, delays the absorption of local anaesthetic and prolongs its action. Steroid adjuvants like dexamethasone can decrease inflammation at the same time demonstrated prolonged analgesic effect. The study aimed at comparing the efficacy of these adjuvants in affecting regional block onset and duration. Materials and Methods: This Randomized, uncontrolled, single blinded, two-arm, concurrent parallel trial was conducted during January to March 2017 among 60 participants posted for forearm and hand surgeries randomly allocated into two groups viz: Group A: 30 subjects given a mixture (30ml) of Bupivacaine (0.25%) and Dexamethasone (8mg) and Group B: 30 subjects given 30ml a mixture (30ml) of Bupivacaine (0.25%) and 1 ml of dexmedotomidine (100µg). The intra and post-operative outcomes of the two groups were compared statistically. Results: The onset of motor and sensory blockade was significantly (p Conclusion: Dexmedotomidine when compared with Dexamethasone used as an adjuvant to Bupivacaine in axillary block for forearm and hand surgeries showed marked efficacy in terms of earlier onset of action, prolonged blockade and longer duration of post-operative analgesia. Keywords: Bupivacaine, Axillary block, Dexmedotomidine, Dexamethasone.

Comparison between lidocaine and 50/50 mixture of lidocaine with bupivacaine when used in inferior alveolar nerve and lingual nerve block for patients undergoing third molar surgery

Aim: The purpose of this study was to compare and evaluate the onset of action, duration of action and analgesia of a 50/50 mixture of lidocaine and bupivacaine when injected for surgical extraction of mandibular third molar. Materials and Method: 50 patients between the age group of 18 to 40 years undergoing bilateral mandibular third molar extractions, reporting to the Department of Oral and Maxillofacial Surgery were chosen for this study. Patients underwent extractions of bilateral mandibular third molars with inferior alveolar nerve and lingual nerve block. Extraction of the mandibular third molar on one side was done using 2.5 NSAIDS) taken was recorded at the end of 5th day.cc of 2% Lidocaine (with 1: 80,000 adrenaline) and the contralateral third molar was extracted using a mixture of 1.25cc of 2% Lidocaine (with 1: 80,000 adrenaline) + 1.25cc of 0.5% Bupivacaine( 50/50 mixture). Onset of action, duration of action was recorded based on EPT (Electronic pulp tester) response. Post operative analgesics ( Results: Independent sample t-test was used for statistical analysis. There was a statistical significant difference between two solutions in terms of both onset and duration of action. The combination of Lidocaine + Bupivacaine offered a prolonged duration of action in the patients undergoing third molar surgery. There was no difference in number of analgesics taken in both the groups. Conclusion: Prolonged duration of action of mixture of local anesthetic agent was not desirable in most minor surgical procedures performed by oral and maxillofacial surgeon. Consumption of NSAIDs noted to be same in both the groups makes no advantage of bupivacaine in terms of analgesia. There was no clinical advantage of mixing two anesthetic solutions even though Statistical differences noted in two parameters studied. Keywords: Lidocaine, Bupivacaine, 50/50 mixture, Third Molar Surgery

Measurement of drug concentration and bacterial contamination after diluting morphine for intrathecal administration: an experimental study

BackgroundLow concentrations of morphine are required for safe dosing for intrathecal injections. Sometimes, manual dilution of morphine is performed to achieve these low concentrations, but risks dilution errors and bacterial contamination. The primary goal was to compare the concentrations of morphine and bupivacaine between four groups of syringes. The secondary goal was to investigate the difference in contamination rate between these groups.MethodsTwenty-five experienced anesthesia providers were asked to prepare a mixture of bupivacaine 2.0 mg/ml and morphine 60 μg/ml using 3 different methods as clean and precise as possible. The fourth method used was the aspiration of ampoules prepared by the pharmacy. The concentrations of morphine and bupivacaine were measured by High-Pressure Liquid Chromatography (HPLC). The medication was cultured for bacterial contamination.ResultsGroup 1 (median 60 μg/ml; 95% CI: 59–110 μg/ml) yielded 3 outliers above 180 μg/ml morphine concentration. Group 2 (76 μg/ml; 95% CI: 72–80 μg/ml) and 3 (69 μg/ml; 95% CI: 66–71 μg/ml) were consistently higher than the target concentration of 60 μg. The group “pharmacy” was precise and accurate (59 μg/ml; 95% CI: 59–59 μg/ml). Group 2 and “pharmacy” had one contaminated sample with a spore-forming aerobic gram-positive rod.ConclusionManually diluted morphine is at risk for deviating concentrations, which could lead to increased side-effects. Medication produced by the hospital pharmacy was highly accurate. Furthermore, even when precautions are undertaken, contamination of the medication is a serious risk and appeared to be unrelated to the dilution process.

Dexmedetomidine as an adjuvant to local anesthetics in ophthalmic surgery

Vitreoretinal surgery aims to restore the structural relationships of the posterior segment of the eye, with the possibility of partial or complete restoration of visual functions, and imposes certain requirements to the anesthetic support of operations. These are injuries, operations length, age, and concomitant pathology of organs and systems of patients. In this regard, there is a recent tendency to use different pharmacological groups as adjuvants to local anesthetics to enhance or prolong their analgesic effect. Purpose to evaluate the effectiveness of dexmedetomidine as an adjuvant in retrobulbar blockades. Materials and methods. Retrobulbar block bupivacaine with dexmedetomidine at a dose of 0.25 mg/kg was performe in the 1st group (n = 22), retrobulbar block was performed with a mixture of bupivacaine in the 2nd group (n = 22). Changes in hemodynamics at the stages of surgery were evaluated. To assess the oxidative status, the evaluation of the redox coefficient (FORT/FORD) was conducted before and after the surgery. The level of comfort of the operation by the surgeon and the patient. Assessment of pain was performed by a VRS in the points. Results. In patients of the 1st group the decrease in SAD was more pronounced and persisted throughout the entire period of surgical treatment. 54.5% of patients of group 1 and 18% of group 2 had no pain 8 hours after the surgery. 82% of patients of group 2 reported moderate pain that required medication (p 0,05). In patients of group 1, it increased from 0.45 0.5 to 0.62 0.2 (p 0,005) by 37% of the initial value, in patients of group 2, it was shown to decrease by 5% (p 0,05). In group 1, the comfort of the operation was estimated by ophthalmic surgeons as satisfactory in 77.3%, and in group 2 in 54.5% (p 0,05). Conclusion. The use of dexmedetomidine as an adjuvant of local anesthetics in ophthalmic surgery provides the necessary analgesia, hemodynamic profile of the patient, antioxidant effect and affects the quality of the surgeons work, which affects the duration of operations.

OUTCOMES OF MULTIMODAL COCKTAIL VS TRANEXAMIC ACID ON POST OPERATIVE PAIN AND BLOOD LOSS IN TOTAL KNEE REPLACEMENT PATIENTS: A PROSPECTIVE RANDOMIZED STUDY

Background: Osteoarthritis is the most common form of arthritis and a leading cause of disability. Total knee replacement (TKR) is one of the most effective surgical procedures, providing improvement in function and relief of pain for the majority of patients. Intra-articular tranexamic acid [TXA] and multimodal cocktail (mixture of ketorolac, tramadol and bupivacaine) are commonly used drugs which help to reduce postoperative bleeding and pain respectively, improving outcome of surgery.
 Objective: To compare the postoperative blood loss and pain with or without Intra-articular tranexamic acid and multimodal cocktail respectively in patients undergoing total knee replacement
 Material and Methods: A total of 96 patients of either gender presenting to Orthopaedics department of Government Medical College, Amritsar, with knee osteoarthritis and planned to undergo total knee replacement were enrolled. Patients were divided into 3 groups. Group A being the control group was not given tranexamic acid [TXA] but only standard drugs for anesthesia. Group B patients were given 3gm intra-articular injection of tranexamic acid. Group C patients were given a multimodal cocktail (mixture of ketorolac, tramadol and bupivacaine. TKR was done and patients were followed-up for 72 hours. Blood loss and pain score after every 24 hours for 72 hours were noted. Intra-articular injections were given just before wound closure.
 Results: The mean age of patients in control group was 48.92±13.22years, in TXA group was 52.31±14.69 years and in cocktail group was 50.22±9.63years. The male to female ratio was 11:21, 14:18 and 10:22 in three groups respectively. The total blood loss during first 72 hours was 1030.1±177.27ml in control group, 453.7±80.4ml in TXA group while 607.7±122.5ml in cocktail group. The difference was significant in all three groups and also between TXA and cocktail group (p<0.05). The mean postoperative pain score during first 72 hours was 4.4±2.3in control group, 2.4±1.5 in TXA group while 1.8±1.0in cocktail group. The difference was significant in all three groups (p<0.05) but insignificant between TXA and cocktail group (p>0.05).
 Conclusion: Results showed that intra-articular injection of TXA is beneficial in reducing blood loss and postoperative pain in comparison to control group. While pain was better controlled with the multimodal cocktail compared to TXA group and control group.
 Keywords: Post-operative blood loss, Intra-articular injection, tranexamic acid, cocktail, total knee replacement

Comparison of the efficacy and duration of desensitization of oral structures following injection of various volumes of a lidocaine-bupivacaine mixture via an infraorbital approach in dogs.

To compare the efficacy and duration of desensitization of oral structures following injection of various volumes of lidocaine-bupivacaine via an infraorbital approach in dogs. 6 healthy adult hound-type dogs. In a randomized crossover study, each dog received 1, 2, and 3 mL of a 2% lidocaine-0.5% bupivacaine mixture (50:50 vol/vol) injected within and near the caudal aspect of the infraorbital canal with a 14-day washout period between treatments. Dogs were anesthetized, and each treatment was administered through a 22-gauge, 4.5-cm-long catheter, which was fully inserted through and then withdrawn 2 cm to the caudal aspect of the infraorbital canal. The reflex-evoked motor potential was measured for the maxillary canine tooth (MC), fourth premolar tooth (MPM4), second molar tooth (MM2), and hard palate mucosa ipsilateral to the injected treatment and for the contralateral MC (control) at predetermined times before and for 6 hours after treatment administration or until the block was no longer effective. For each oral structure, the proportion of dogs with desensitization (efficacy) and time to onset and duration of desensitization were compared among the 3 treatments (injectate volumes). Treatment was not associated with efficacy, time to onset, or duration of desensitization. Regardless of treatment, MC and MPM4 were more frequently desensitized and mean durations of desensitization for MC and MPM4 were longer, compared with those for MM2 and the hard palate. The volume of local anesthetic used for an infraorbital nerve block had no effect on block efficacy or duration.

Determining anatomic accuracy of shoulder field injection: triangular injection technique does adequately reach pain transmitters

BackgroundControlling pain after shoulder surgery is a critical component of postsurgical care. Several recent studies have described the use of periarticular, local infiltration anesthesia, and field blocks (FBs) with clinical efficacy after shoulder surgery. The anatomic accuracy and safety of these FBs have not been well described. The purpose of this study was to determine the accuracy of a surgeon performed shoulder field injection. We hypothesized that our field injection would adequately reach the pain transmitters responsible for postsurgical shoulder pain.MethodsA total of 10 cadaveric specimens were used in the study. A mixture of liposomal bupivacaine, normal saline, and methylene blue totaling 60 cc was prepared. After injection, the specimens were left for 4 hours to allow medication diffusion. The dissection of specimens was performed to identify 4 areas: axillary nerve, suprascapular nerve, supraclavicular nerves, and joint capsule. On dissection, accuracy rates were determined for each area.ResultsAll 10 cadaveric specimens were injected and dissected to completion. The dissection of the axillary nerve showed methylene blue dye surrounding the nerve in 10 of 10 (100%) specimens, the suprascapular nerve in 9 of 10 (90%), and the supraclavicular nerves in 10 of 10 (100%). Zero of 10 (0%) specimens had any dye penetrate into the glenohumeral joint or capsule.ConclusionThe accuracy rates of the injection of the mixture into the shoulder specimens suggest potential to reproduce an FB to the tissues that are responsible for postoperative pain after shoulder surgery. This may represent an option when interscalene nerve block is not desired or contraindicated.

Comparison between two mixtures of lidocaine and bupivacaine for infraclavicular block: a double blind randomized trial

Background: We compare the two mixtures in terms of efficiency, analgesia, and side effects.Methods: 30 patients scheduled for upper limb surgery were randomized in 2 groups. the group A received a mixture of 50% lidocaine 2% and 50% of bupivacaine 0.5% the group B received a mixture of 75% lidocaine 1% and 25% of bupivacaine 0.5%. Volumes, block onset times, blocks duration times, analgesia, and toxicity were compared.Results: The volumes were equals in both groups. Sensory block onset was 5.43 min in the group A versus 6.73 min in the group B, motor block onset was 11.93 for the group A versus 13.46 min for the group B. Sensory block duration was 5.48 hours in the group A versus 4.05 hours for the group B (p=0.037), motor block duration was 7.75 hours for group A versus 5.50 hours for group B (p=0.014). Analgesia levels are equals between the two groups, there was no side effects listed.Conclusions: The use of low concentrated lidocaine and bupivacaine mixture induces an adequate anaesthesia and decreases the duration of motor block with a reduced level of pain and an equal level of analgesia.

Comparison of the pharmacological properties of 0.375% bupivacaine with epinephrine, 0.5% ropivacaine and a mixture of bupivacaine with epinephrine and lignocaine – a randomized prospective study

One of the methods of anesthesia for orthopedic and plastic procedures for the upper limb is the brachial plexus block. The aim of the study was to compare the pharmacodynamic and pharmacokinetic properties of three commonly used local anesthetic solutions used for axillary brachial plexus blockade. Sixty patients scheduled for surgery of the upper limb were enrolled for the study. 3 different local anesthetic solutions: 0.375% bupivacaine with epinephrine (group B), 0.5% ropivacaine (group R) and a mixture of 0.5% bupivacaine with epinephrine and 2% lignocaine in a 1:1 ratio (group BL) were used to anesthesia. The study assessed the delay time of sensory and motor blockade and the duration of sensory and motor anesthesia of the operated limb. There were no significant differences in the onset of sensory block between the study groups. In the BL group, the onset of the motor block was significantly shorter than in group B and group R. The duration of the sensory and motor blockade was significantly longer in group B and group R than in the group BL. The solution of 0.375% bupivacaine with epinephrine and 0.5% ropivacaine used for axillary brachial plexus anesthesia provide the same level of the block. Addition of short acting local anesthetic – lignocaine to long acting bupivacaine decreases the time to onset of motor blockade, but also shortens the duration of the sensory and motor blockade in the post-operative period, compared to long acting local anesthetics of higher potency: bupivacaine with epinephrine or ropivacaine.

Truncal injection brachial plexus block: A Description of a novel injection technique and dose finding study.

Background and Aims:Brachial plexus (BP) blocks continue to be described with reference to anatomical landmarks (Interscalene and Supraclavicular), even after the introduction of ultrasound which enables us to directly identify the roots, trunks and divisions of the BP. The aim of this study was to describe a novel injection technique targeting trunks of BP and to determine the minimum effective local anaesthetic volume (MELAV) required to produce BP block with this approach.Methods:Twenty-one male patients in the age group 20–40 years, undergoing elective forearm bony procedures received an ultrasound-guided truncal injection BP block. MELAV50 was determined using the Dixon and Mood up-and-down method. Initial volume of local anaesthetic (LA; 50:50 mixture of bupivacaine 0.5% and lignocaine 2% with 5 μg/ml epinephrine) injected was 6 ml in each trunk, which was varied by 1 ml/trunk for each consecutive patient according to the response of the previous patient. The MELAV50, MELAV95 and MELAV99 were calculated using Probit transformation and logistic regression.Results:Out of the 21 patients, 13 patients had a successful block. The MELAV50, MELAV95 and MELAV99 were 7.41, 10.47 and 12 ml, respectively. Eight patients in whom block failed had sparing in the ulnar and median nerve territories.Conclusion:Trunks of the brachial plexus can be identified and targeted for the injection of local anaesthetics. The MELAV50 and MELAV95 required for ultrasound-guided truncal injection brachial plexus block were 7.4 and 10.4 ml, respectively.

Tramadol as an adjuvant to peribulbar anesthesia

Background A large number of additives have been used as an adjuvant to local anesthetic (LA) mixture in peribulbar block to fasten the onset, enhance the potency, and prolong the duration of the block to cover the long duration of vitreoretinal surgeries and provide better postoperative analgesia. The authors designed a prospective, randomized, double-blind, controlled clinical trial to assess the effect of adding tramadol 20 mg to standard LA mixture concerning the onset of lid and globe akinesia, time for satisfactory block, and duration of postoperative akinesia and analgesia. Patients and methods A double-blind randomized study was done on 80 American Society of Anesthesiologists I and II patients scheduled for elective vitreoretinal surgery. Patients were chosen randomly into two groups, with 40 patients in each group. Group I (control group) received a mixture of bupivacaine 0.5% (4 ml)+lidocaine 2% (4 ml)+hyaluronidase 150 IU (1 ml) with 1 ml normal saline to a total volume of 10 ml. Group II (tramadol group) received a mixture of bupivacaine 0.5% (4 ml)+lidocaine 2% (4 ml)+hyaluronidase 150 IU (1 ml) supplemented with 20 mg tramadol in 1 ml normal saline to a total volume of 10 ml. The onset and duration of lid and globe akinesia and optimum time to begin surgery were recorded, in addition to postoperative visual analog score, duration of analgesia, and time to first rescue analgesic request. Results The results show statistically significant differences between the two groups, as tramadol group had faster onset of akinesia, better akinesia score, and shorter time needed to start surgery. In addition, tramadol group also showed significantly prolonged postoperative analgesia and akinesia with lower median pain score and less postoperative analgesic requirements. Conclusion The present study concluded that tramadol is a safe adjuvant to LA in peribulbar block that fastens the onset and prolongs the duration of lid and globe akinesia and improves the quality of analgesia without any obvious adverse effects.

Laparoscopic Assisted Posterior Transverse Abdominis Plane (Tap) Block

Video Objective This video demonstrates a laparoscopic assisted transverse abdominis plane (TAP) block as an alternative to the traditional anesthesiology-driven ultrasound-guided TAP block to reduce postoperative pain. Setting Our patient is a 49 year old with endometriosis, abnormal uterine bleeding, and fibroids, who undergoes a total laparoscopic hysterectomy. Interventions Following removal of the specimen and closure of the vaginal cuff, we inject a mixture of liposomal bupivacaine and regular bupivacaine between the transverse abdominis and internal oblique muscles. We use external and internal anatomic landmarks such as the iliac crest, latissimus dorsi muscle, and the transverse abdominis muscle to target the Triangle of Petit when placing the injection under direct visualization. This supplies analgesia to the parietal peritoneum, skin, and muscles along T8 through L1 dermatomes. The patient did not require any postoperative opioid based medications. Conclusion The laparoscopic assisted TAP block is a safe, effective, and quick strategy to reduce pain after minimally invasive gynecologic surgery.

Effect of Bupivacaine Liposome Injectable Suspension on Sensory Blockade and Analgesia for Dupuytren Contracture Release

To study the efficacy of bupivacaine liposome injectable suspension in prolonging sensory blocks of the median and ulnar nerves for subjects with Dupuytren contracture release by collagenase injection. We hypothesized that combining liposome bupivacaine and bupivacaine hydrochloride would extend the duration of blocks without added complications. We randomized 32 subjects scheduled for Dupuytren contracture release with collagenase Clostridium histolyticum injections to receive forearm blocks of the median and ulnar nerves with a mixture of 5 mL liposome bupivacaine 1.33% plus 2.5 mL bupivacaine hydrochloride 0.5% per nerve (n= 16) or 7.5 mL bupivacaine hydrochloride 0.5% alone per nerve (n= 16). Sensory block and analgesia were assessed through the first posttreatment week. Sensory block was nearly 4 times longer in subjects who received the liposome bupivacaine mixture compared with subjects who received bupivacaine hydrochloride alone. Most subjects (13 of 16) who received the liposome bupivacaine mixture had adequate analgesia for finger manipulation to rupture the cords, whereas most subjects (15 of 16) who received bupivacaine hydrochloride alone required additional anesthesia. Subjects in the liposome mixture group reported lower pain scores through the first 3 days after treatment. There were no serious side effects. Addition of liposome bupivacaine to forearm blocks for Dupuytren contracture release prolonged sensory block and improved pain scores without increasing side effects or impairing hand function. Supplemental lidocaine injections for the painful phases of Dupuytren contracture release with collagenase C histolyticum injections were not required by most subjects who received liposome bupivacaine. Therapeutic I.

A novel method for pain control: infiltration free local anesthesia technique (INFLATE) for transrectal prostatic biopsy using transcutaneous electrical nerve stimulation (TENS).

To describe a novel method for the control of pain during prostate biopsies, infiltration free local anesthesia technique (INFLATE) for transrectal prostatic biopsies with no further needle insertions for local anesthetic infiltration. A total of 138 men with elevated prostate-specific antigen levels and/or abnormal digital rectal examination findings were included in the study. Of the patients, 73 were assigned to the INFLATE group and 65 to the TRUS-PNB group. Demographic data, PSA levels, findings of digital rectal examinations, and multiparametric prostatic magnetic resonance imaging were recorded. In the INFLATE group, a two-channel TENStem eco basic device with two electrodes was used for pain control during the biopsy. For the TRUS-PNB group, 60mg lidocaine gel was given intrarectally in addition to infiltration of a prilocaine and bupivacaine mixture (5mL of 2% prilocaine + 5mL of 0.25% bupivacaine). Pain perception was assessed using a linear numeric rating scale. The mean ages, BMIs, prostate volumes, and PSA levels were similar between the two groups (p > 0.05). Of the 56 participants with prostate adenocarcinoma, 28 were in the INFLATE group, and 28 were in the TRUS-PNB group with a 40.6% overall cancer detection rate. The mean preoperative and post-operative pain scores during probe insertion, biopsy and post-biopsy were similar between the groups (p > 0.05). The results of the study confirmed that INFLATE for transrectal prostate biopsy using a TENS device could safely and effectively be used for pain control with the advantage of two fewer needle attempts with no increase in significant complications.

Brachial plexus block as a part of balanced anesthesia in a jungle cat (Felis chaus) undergoing forelimb orthopedic surgery

An adult male jungle cat (Felis chaus) weighing 6 kg with the history of inability to bearing weight on its left forelimb was presented. Physical examination and radiography revealed transverse radio-ulna fracture and carpal subluxation. Internal fixation with plate was chosen for treatment. On the day of surgery, anesthesia was induced with intramuscular ketamine (10 mg/kg) and midazolam (0.3 mg/kg). Brachial plexus block (BPB) was performed using lidocaine (3 mg/kg) and bupivacaine (0.75 mg/kg) mixture guided by an electrical nerve stimulator. During the surgery, anesthesia was maintained with isoflurane 0.5–1% in 100% oxygen. Heart rate, respiratory rate, rectal temperature, hemoglobin oxygen saturation, and end-tidal carbon dioxide tension remained stable during surgical procedure. The outcome of the present case suggests that combination of BPB and general anesthesia can be used to provide balanced anesthesia in wild felids. Reducing the isoflurane requirement and providing sufficient anti-nociception during surgery without any adverse effect are the main advantages of this protocol.

Effect of Adding Dexmedetomidine to Bupivacaine in Ultrasound Guided Rectus Sheath Block: A Randomized Controlled Double-blinded Study

Background: Extended midline laparotomy incision is accompanied by intense pain postoperatively which affects patients’ physiology; therefore, good control of postoperative pain is mandatory to decrease the adverse effects on the body. Ultrasound-guided Bilateral Rectus Sheath Block (BRSB) is one of the options to achieve this goal. Objective: The study aimed to assess the analgesic potency of adding dexmedetomidine to bupivacaine in ultrasound-guided BRSB in cancer patients with a midline laparotomy incision. Methods: Sixty adult cancer patients planned for laparotomies with extended midline incision were included. Ultrasound-guided BRSB was performed immediately after the induction of anesthesia. Patients were classified randomly into two groups; B group, where only bupivacaine was used for BRSB and BD group in whom a mixture of bupivacaine and dexmedetomidine was used. Results: A significant decrease in visual analogue scale scores, total morphine consumption, postoperative nausea and vomiting and postoperative cortisol levels was observed in group BD. Conclusion: Dexmedetomidine as an adjuvant to bupivacaine in US-guided rectus sheath block bilaterally proved to be effective for proper pain management postoperatively in cancer patients after extended midline abdominal incision.

Effectiveness of Mixture of Xylocaine, Bupivacaine and Buprenorphine for Lumbar Blockade by Epidural Approach

Background: Pain is one of the most compelling experience for human beings. Pain is the most difficult one to define and assess, as it is a purely subjective sensation experienced only by the sufferer. Present study was done in which Buprenorphine was given epidurally along with Bupivacaine and Xylocaine as a single shot technique to evaluate its potency, duration of analgesia and other side effects. Subjects and Methods: Fifty adult patients of ASA risk I/II undergoing lower abdominal surgery, lower limb - orthopaedic surgery, surgery involving perineal region and gynaecological procedures were selected for our study. The patients were divided into two groups consisting of 25 patients each. In group I, patients were given Inj. Bupivacaine 0.5% 20 cc + xylacaine in lumbar epidural space. In group II, patients were given Bupivacaine 0.5% 20 cc + xylacaine 0.5% 20 cc mixed with Inj. Buprenorphine 0.2 mg (2 ml) in same syringe in lumbar epidural space. Duration of total analgesia was measured with help of pain scorre, which were measured throughout operative period and in postoperative period. All the statistical tests will be performed in SPSS version 15 software. Results: In study group majority patients complain of pain at around 16 to 20 hours. Most of the patients in group-I are in 0-4 hours and in group – II are 20-24 hours. Maximum respiratory depression was around 12% (2/min). It was observed that hypotension was seen in 4 cases and bradycardia in 4 cases – intraoperatively and postoperatively no patient had bradycardia or hypotension in study group. Conclusion: Buprenorphine if given epidurally along with local anesthetic solution for various surgical procedures can provide excellent pain free period lasting up to 24 hours without any disturbances to normal physiology life and notable side effects.

Efficacy of fluoroscopy-guided triple shoulder injection for older patients with nonspecific shoulder pain.

Nonspecific shoulder pain is a common complaint in older adults that impairs physical function by restricting the range of joint movement, and causing severe pain. The study evaluated the effects of fluoroscopy-guided triple shoulder injection [i.e., injection into glenohumeral (GH) joint, subacromial (SA) space, and acromioclavicular (AC) joint] on pain, function, and range of motion in older patients with nonspecific shoulder pain. A total of 43 patients who were aged 65years and older and diagnosed with nonspecific shoulder pain were included in this prospective, non-randomized clinical trial; 65.1% of the patients were female and mean age was 70.2 ± 5.0. Under fluoroscopic guidance, a mixture of methylprednisolone and bupivacaine was injected into the GH joint, SA space and AC joint. Patients were evaluated as per the Numeric Rating Scale for Pain (NRS-Pain), the Shoulder Pain and Disability Index (SPADI), and the active range of motion (AROM) at baseline, and again at 3 and 12weeks after the injection. A statistically significant improvement was detected in NRS-Pain, SPADI, and AROM at 3 and 12weeks after injection compared with baseline. The change in SPADI score from baseline was higher than the minimal detectable change in 67.4% of patients at 12weeks. The SPADI score at baseline was positively correlated with the post-injection SPADI score at 3 and 12weeks. In older patients with nonspecific shoulder pain, fluoroscopy-guided triple shoulder injection provides significant improvements in pain and physical function with low complication rates during the 12-week follow-up.

Spinal versus General Anaesthesia for Laparoscopic Gynaecological Procedures: A Comparative Study of Haemodynamic Changes and Side Effects

Introduction: Laparoscopic gynaecological procedures are conventionally done under general anaesthesia. Spinal anaesthesia is usually preferred only in patients where general anaesthesia is contraindicated. For laparoscopic gynaecological procedures sub arachnoid block is gaining popularity day by day as it is a good alternative to GA.
 Objective: To compare haemodynamic changes and side effects between subarachnoid block (SAB) and general anaesthesia (GA) for lower abdominal laparoscopic gynaecological procedures.
 Materials and Methods: A total number of sixty female patients were considered and divided equally into two groups as per American Society of Anesthesiologists (ASA) grade I and II. All patients underwent short duration (<1hr) laparoscopic gynaecological procedures. Group-I patients received lumber SAB and group-II patients received standard general anaesthesia using Propofol, Halothane and Fentanyl. Peri-operative heart rate, blood pressure, Electro-cardiogram (ECG) and Saturation of Oxygen (SPO2) were monitored. Any intra operative and post operative side effects were also recorded and managed.
 Results: Intra operative and post operative heart rate, systolic and diastolic blood pressure were significantly higher (P<0.05) in group-II. Preoperative, per operative and post operative mean blood pressure (MBP) were also significantly higher (P<0.05) in group-II. During intraoperative period, the side effects in group-I were mainly discomfort and shoulder tip/neck pain and in group-II were hypertension and arrhythmia. Postoperative side effects were mainly postoperative nausea and vomiting (PONV).
 Conclusion: Spinal anaesthesia using mixture of bupivacaine and fentanyl can be used as a safe alternative to GA for short duration gynaecological laparoscopic procedures with minimum haemodynamic alterations and reduced post operative side effects. To alleviate shoulder tip/neck pain or discomfort patient needs supplementary sedation and analgesia.
 Journal of Armed Forces Medical College Bangladesh Vol.11(2) 2015: 20-24

Ropivacaine plus lidocaine versus bupivacaine plus lidocaine for peribulbar block in cataract surgery: A prospective, randomized, double-blind, single-center, comparative clinical study

Background and Aims:Cataract surgery in ophthalmology is usually done under peribulbar block with a mixture of 0.5% bupivacaine and 2% lidocaine. Several case reports of fatalities associated with bupivacaine has necessitated a search for alternative safe agents. The aim of this study was to compare peribulbar block characteristics using a mixture of 0.5% bupivacaine and 2% lidocaine with a mixture of 0.5% ropivacaine and 2% lidocaine.Material and Methods:Eighty patients were allocated to two random groups of 40 each. Patients of groups BL and RL were given 4 ml of 0.5% bupivacaine and 4 ml of 0.5% ropivacaine each in a mixture with 4 ml of 2% lidocaine and 100 IU of hyaluronidase respectively. Block characteristics, hemodynamic variables, adverse drug interactions and other complications were recorded.Results:Demographic characteristics were comparable in both the groups. Duration of onset of the block and the side effect profile was comparable in both the groups but the total duration of the block and the time for first rescue analgesia was found to be longer in group BL than in group RL.Conclusions:Ropivacaine 0.5% and lidocaine 2% as a 1:1 mixture in a volume of 8 ml with 100 IU of hyaluronidase is as effective as a 1:1 mixture of bupivacaine 0.5% and lidocaine 2% in a volume of 8 ml with 100 IU of hyaluronidase with regards to onset and total duration of the block and side effects and hemodynamic changes.