Ml Of Bupivacaine Research Articles

Pneumothorax following serratus anterior plane block

Serratus anterior plane blocks may provide analgesia for rib fractures, thoracic surgery and breast surgery. There remains uncertainty regarding the location of injection, be it superficial or deep to the serratus anterior muscle. We describe the case of a 63-year-old ASA physical status 3 woman undergoing a wire-guided wide local excision of a right breast lump. A modified right serratus anterior plane block was performed under ultrasound guidance, injecting 20ml of bupivacaine 0.25% deep to the serratus anterior muscle. No immediate complications were noted. Intra-operatively the patient developed arterial desaturation associated with high airway pressures. A subsequent chest radiograph in the post-anaesthetic care unit demonstrated a large right-sided pneumothorax which was treated with immediate needle decompression and chest drain insertion. This is the first case of pneumothorax reported from this approach to serratus anterior plane blockade and serves as a reminder of a potential serious complication.

Effect of stellate ganglion block versus intraluminal application of verapamil-nitroglycerine solution on internal mammary artery graft blood flow rate in patients undergoing on-pump coronary artery bypass grafting

Background Left internal mammary artery (IMA) graft is the most promising arterial conduit for coronary artery bypass grafting. Stellate ganglion block (SGB) induces sympathetic blockade and is used to prevent or control spasm of the internal mammary artery. The purpose of this study was to investigate the effect of left SGB on left IMA blood flow rate. Patients and methods A total of 170 patients aged between 65 and 70 years, with American Association of Anesthesiologists physical status II and III, and scheduled for elective coronary artery bypass grafting, were randomly allocated to either a SGB group or a verapamil-nitroglycerine group. In the SGB group, the patients received SGB using 8 ml of bupivacaine 0.25%. In the verapamil-nitroglycerine group, the patients received intraluminal injection of the harvested IMA graft with a solution, containing verapamil 5 mg, nitroglycerine 2.5 mg, heparin 500 U, 8.4% NAHCO3 0.2 ml, and ringer solution 40 ml, throughout its whole length using a small syringe, and with a low dose of intravenous nicardipine infusion started after harvesting (5 mg nicardipine in 100 ml saline at a rate of 0.5 mg or 10 ml/h). IMA blood flow rate (primary outcome), abnormal ECG changes, ICU length of stay, intra-aortic balloon usage, pre–postoperative pulse rate and blood pressure, incidence of atrial fibrillation, radio-femoral arterial pressure difference, pre–postoperative ejection fraction, need for re-exploration, and mortality rate were observed. Results This prospective study showed a significant increase of IMA blood flow rate (P Conclusion The results of this study showed that SGB prevents IMA spasm, increases its blood flow rate, and decreases incidence of atrial fibrillations compared with intraluminal injection of verapamil and nitroglycerine combined with intravenous nicardipine.

Comparison of levobupivacaine and bupivacaine in fascia iliaca compartment block (FICB) for postoperative pain management in surgeries for fractures of neck of femur

Background and aims: Hip fractures are painful and usually affects elderly patients. If left untreated or under-treated, post-operative pain may increase the length of hospital stay and delayed ambulation. The use of peripheral nerve blocks in this population can significantly reduce the associated mortality and morbidity, without the side effects of systemic analgesics. We conducted this study to compare the use of levobupivacaine with bupivacaine in fascia iliaca compartment block (FICB) for postoperative pain management in surgeries for fractures of neck of femurMethodology: This prospective, randomised, double blind study was carried out after approval from the ethical committee and obtaining written informed consent. We enrolled 45 patients undergoing surgery under spinal anesthesia for extracapsular fractures of proximal femur and divided into 3 groups (15 each). Group L: received FICB with 30 ml of levobupivacaine 0.25% (75 mg). Group B: received FICB with 30 ml of bupivacaine 0.25% (75 mg). Group T: no block given. After 30 min patients were shifted to operating room and administered spinal anesthesia in sitting position. Primary outcome was total analgesic consumption in 24 h. Secondary outcomes- patient comfort during positioning for spinal, sensory onset time, postoperative VAS, and time to first analgesic request were registeredResults: Cumulative analgesic consumption was significantly lower in Groups L (93.33 ± 59.362 mg) and B (126.67 ± 45.774 mg) as compared to Group T (273.33 ± 79.881 mg); no significant difference was found between Groups L and B. The time to first analgesicrequest in Group L was 877.33 ± 355.673 min, Group B was 845.33 ± 379.997 min and Group T was 202.67 ± 142.351 min. Patient comfort on positioning was lowest in Group T.Conclusion: Administration of FICB in patients undergoing surgery for fractures of proximal femur led to a significant reduction in postoperative pain as compared to systemic analgesics alone. The use of equal concentration of levobupivacaine as compared to bupivacaine provided no added advantage.Background and aims: Hip fractures are painful and usually affects elderly patients. If left untreated or under-treated, post-operative pain may increase the length of hospital stay and delayed ambulation. The use of peripheral nerve blocks in this population can significantly reduce the associated mortality and morbidity, without the side effects of systemic analgesics. We conducted this study to compare the use of levobupivacaine with bupivacaine in fascia iliaca compartment block (FICB) for postoperative pain management in surgeries for fractures of neck of femurMethodology: This prospective, randomised, double blind study was carried out after approval from the ethical committee and obtaining written informed consent. We enrolled 45 patients undergoing surgery under spinal anesthesia for extracapsular fractures of proximal femur and divided into 3 groups (15 each). Group L: received FICB with 30 ml of levobupivacaine 0.25% (75 mg). Group B: received FICB with 30 ml of bupivacaine 0.25% (75 mg). Group T: no block given. After 30 min patients were shifted to operating room and administered spinal anesthesia in sitting position. Primary outcome was total analgesic consumption in 24 h. Secondary outcomes- patient comfort during positioning for spinal, sensory onset time, postoperative VAS, and time to first analgesic request were registeredResults: Cumulative analgesic consumption was significantly lower in Groups L (93.33 ± 59.362 mg) and B (126.67 ± 45.774 mg) as compared to Group T (273.33 ± 79.881 mg); no significant difference was found between Groups L and B. The time to first analgesic request in Group L was 877.33 ± 355.673 min, Group B was 845.33 ± 379.997 min and Group T was 202.67 ± 142.351 min. Patient comfort on positioning was lowest in Group T.Conclusion: Administration of FICB in patients undergoing surgery for fractures of proximal femur led to a significant reduction in postoperative pain as compared to systemic analgesics alone. The use of equal concentration of levobupivacaine as compared to bupivacaine provided no added advantage.Citation: Raiger LK, Gehlot RK, Bedi V, Betkeker SA. Comparison of levobupivacaine and bupivacaine in fascia iliaca compartment block (FICB) for postoperative pain management in surgeries for fractures of neck of femur. Anaesth pain & intensive care 2019;23(3):284-289

Dexamethasone an adjuvant in brachial plexus block : Supraclavicular approach: An observational randomised double blind clinical study

Background : Brachial plexus blockade via supraclavicular approach for upper limb surgery can significantly reduce pain, decreases the need for post operative analgesics, decreases the incidence of nausea and vomiting, increases patient satisfaction and allows for faster discharge from hospital when compared with general anesthesia. Aim is to study the use of an adjuvant Dexamethasone with local anesthetic bupivacaine and lignocaine with adrenaline for the onset of sensory block, onset of motor block and the duration. Materials and Methods: This is a prospective, comparative and observational study of 60 patients who were divided randomly into two groups with each 30 patients: GROUP C received 15 ml of bupivacaine 0.5%, 15ml of 2% lignocaine with adrenaline and 2ml of normal saline to a total volume of 32ml. GROUP D received 15 ml of bupivacaine 0.5%, 15ml of 2% lignocaine with adrenaline and 2ml of Dexamethasone to a total volume of 32ml. Statistical Analysis : Cross tabs, Independent Samples t test, Repeated Measure ANOVA were used. SPSS for windows (version 17.0) was employed for data analysis. Results : Demographic parameters like age, weight, height, BMI were comparable between the two groups with p value >0.05 We observed that, onset of both sensory and motor block was earlier in group D and duration of sensory block and motor block was more in group D. Also, there was less requirement of rescue analgesics in group D. Conclusion: Dexamethasone added to the routine local anesthetic bupivacaine and 2% lignocaine and adrenaline is an effecient and safe choice for rapid onset and increases the duration of oth sensory and motor block in brachial plexus block. Keywords: Brachial plexus, Supralavicular approach, Dexamethasone

Intradermal Sterile Water Injection versus Epidural Bupivacaine in Painless First Stage of Labor

Background: Many women have moderate to severe low back pain during labor. It has been shown that injection of sterile water can reduce the pain of 1ststage. This method is very cheap, easy to learn and can be used as alternative method for reducing the labor pain. Objectives: The aim of this study was to compare the effectiveness, women satisfaction safety and safety of intradermal sterile water injection and epidural bupivacaine in decreasing the pain of1st stage of labor. Patients and Methods: After approval of Institutional Ethical Committee and obtaining written informed consent from eligible parturient women, 120 healthy parturient divided into 3 groups. 1st group epidural bupivacaine plus fentanyl, Initiated with 10 ml of bupivacaine 0.125% with 2 micrograms/ ml of fentanyl and maintained with 10 ml/ h of the same mixture. 2nd group intradermal injection of sterile water 0.1 ml, while 3rd group intradermal injection of 0.1 ml normal saline. Results: The study reported good pain relief in epidural and sterile water group compared to normal saline group. Pain relief was comparable in both the epidural and sterile water group. Complications were more demonstrated in epidural compared to the sterile water and the normal saline groups. A good maternal satisfaction in epidural and sterile water group with no satisfaction in the normal saline group. Conclusion: The evidence from this study suggests that sterile water injections are safe and effective method for relieving pain of the 1st stage of labor similar to epidural bupivacaine analgesia.

COMPARISON OF INTRATHECAL BUPIVACAINE WITH OR WITHOUT CLONIDINE FOR PERIOPERATIVE ANALGESIA IN LOWER LIMB ORTHOPEDICS SURGERIES

Background: The newer adjutants for spinal anaesthesia (SA) have seen numerous modifications over the last two decades. Various doses of clonidine have been tried in past but optimal dose which balances the ill effects has to be discovered. Therefore, this study was designed to study the effect of clonidine as an adjuvant in SA in terms of duration and complication.
 Methods: Two groups I and II ( with 60 patients each) received either 3.0 ml of Bupivacaine 0.5% heavy + 0.5 ml of normal saline and 2.5 ml of bupivacaine 0.5% heavy + 0.5 ml (75µg) of preservative free clonidine respectively. Various haemodynamic parameters and complication were recorded at baseline than 30 min, 1,2,4,6 and 8 hours after SA.
 Results: Group II shows that addition of clonidine had altered the heart rate and blood pressure significantly for initial two hour duration(p<0.05). No difference in the onset of sensory and motor blockade in both groups. Majority of patients in both group had level of sensory block upto T7 level. Mean VAS score was significantly lower in group II (p<0.001). Group II has prolonged duration of motor blockade (p< 0.00l). The difference in mean duration of analgesia among both the groups was significant indicating that addition of clonidine prolongs the duration of analgesia (p<0.0001). In group II incidence of hypotension and bradycardia is more as compared to group I.
 Conclusion: Intrathecal clonidine in the dose of 75 µg along with bupivacaine 0.5% heavy prolonged postoperative analgesia and motor blockade. It produces sedation in which patients were asleep and easily arousal and haemodynamic changes which could be easily managed.
 Keywords: Intrathecal, Bupivacaine, Clonidine, Orthopedics surgeries, VAS score

The efficacy of adjuvants to bupivacaine in ultrasound-guided supraclavicular block: a comparative study between dexmedetomidine, ketamine, and fentanyl

BackgroundUltrasound-guided supraclavicular block is of increasing importance in upper limb surgeries as it provides excellent pain control and reduced side effects. The search for the ideal adjuvant is still present. In this study, we aim to evaluate the efficacy and safety of dexmedetomidine, ketamine, and fentanyl when added to bupivacaine in ultrasound-guided supraclavicular block.Patients and methodsA total of 60 patients with American Society of Anesthesiologists (ASA) I and II scheduled for upper limb surgeries were randomly assigned into three groups (20 patients each): group DB received 38 ml bupivacaine 0.5% with 2 ml (100ug) dexmedetomidine. Group KB received 38 ml bupivacaine 0.5% with 2 ml (100 mg) ketamine. Group FB received 38 ml of bupivacaine 0.5% with 2 ml (100ug) fentanyl. We measured sensory/motor block, sedation level, adverse effects, the total amount of rescue analgesia, and post-operative pain.ResultsThere was a significant increase in the duration of sensory and motor block in the DB group with no difference in the onset. The mean blood pressure and heart rate were lower in the DB group. Analgesic effects of dexmedetomidine were higher, followed by ketamine and lastly fentanyl. Post-operatively visual analogue scale (VAS) and rescue analgesia results indicated that dexmedetomidine and ketamine provided adequate post-operative analgesia.ConclusionAddition of dexmedetomidine was more effective in prolongation of the sensory and motor duration as well as providing adequate intra-operative analgesia when compared to ketamine and fentanyl. Dexmedetomidine and ketamine are effective and safe in post-operative analgesia.

Efficacy of Atlantoaxial Joint Glucocorticoid Injection in Patients with Rheumatoid Arthritis: A Randomized Trial

Background: The atlantoaxial joint (AAJ) plays a pivotal role in the cervical spine motion. Unfortunately, it is the most common cervical spine joint that is affected in patients with rheumatoid arthritis. Inflammation of the AAJ results in neck disability, nerve root compression, and finally spinal cord compression. Objectives: We aim to evaluate the efficacy of intraarticular triamcinolone injection of the AAJ on neck pain and disability. Study Design: A prospective randomized, controlled clinical trial. Setting: An interventional pain unit in a tertiary center at a university hospital in Egypt. Methods: Sixty patients with rheumatoid arthritis complaining of AAJ arthritis were randomized into 2 groups. Group AAJI (n = 30) received AAJ injection with 1.0 mL of a mixture of 0.5 mL of bupivacaine 0.5% and 0.5 mL of 20 mg of triamcinolone, in addition to oral placebo tablets (2 tablets every 8 hours for one week). Group SS (n = 30) received systemic steroids, oral prednisolone tablets (5 mg, 2 tablets every 8 hours for one week), in addition to AAJ injection with 1.0 mL of a mixture of 0.5 mL of bupivacaine 0.5% and 0.5 mL of normal saline solution. The percentage of patients who showed ≥ 50% reduction of their visual analog scale (VAS) pain score (measured at 1, 2, and 3 months postoperatively), VAS pain score and neck disability index (NDI) (measured at 2, 4, 6, 8, and 12 weeks postoperatively), and the magnetic resonance imaging (MRI) changes of AAJ (assessed 4 weeks postoperatively) were all evaluated. Results: There was significant reduction in the percentage of patients who showed ≥ 50% reduction of their VAS pain score postoperatively in group AAJI compared with group SS at one month (75% vs. 46.45%; P = 0.033), 2 months (60.7% vs. 25%; P = 0.009), and 3 months (53.6% vs. 17.9%; P = 0.007). There was significant reduction in overall VAS and overall NDI in group AAJI compared with group SS (mean ± standard error) (41.5 ± 2.6 vs. 52.1 ± 2.6; P = 0.005) and (43.7 ± 3.1 vs. 52.4 ± 3.1; P = 0.040), respectively. Analysis of postoperative MRI findings revealed significant improvement of bone marrow edema in group AAJI (AAJI vs. SS) (71.4% vs. 42.9%; P = 0.033), also the synovial enhancement disappeared significantly in group AAJI compared with group SS, (16/22 [72.7%] vs. 10/23 [43.5%]; P = 0.026), moreover, there was a significant reduction in pannus size in group AAJI compared with group SS, (6/10 [60%] vs. 1/9 [11%]; P = 0.041). Limitations: The study follow-up period was limited to only 3 months. Conclusions: For acutely inflamed AAJ due to rheumatoid arthritis, AAJ steroid injection is a potential therapeutic option; it decreased cervical neck pain, improved neck mobility, and hastened recovery of the joint from an acute inflammatory stage. Key words: Rheumatoid arthritis, atlantoaxial joint injection

Ultrasound-Guided Erector Spinae Plane Block in Patients Undergoing Open Epigastric Hernia Repair: A Prospective Randomized Controlled Study.

Hernia repair is associated with considerable postoperative pain. We studied the analgesic efficacy of bilateral ultrasound-guided erector spinae plane block in patients undergoing open midline epigastric hernia repair (T6-T9). Sixty patients 18-65 years of age were randomly allocated into 2 groups. Patients in the erector spinae plane block group received bilateral ultrasound-guided erector spinae plane block at the level of T7 transverse process using 20 mL of bupivacaine 0.25% on each side, while the control group received bilateral sham erector spinae plane block using 1 mL of normal saline. All patients underwent general anesthesia for surgery. Pain severity (visual analog scale), consumption of intraoperative fentanyl, time to first request of rescue analgesia, and postoperative pethidine consumption were recorded over the first 24 hours postoperatively. At 2 hours postoperatively, the visual analog scale pain score was significantly lower in the erector spinae plane block group compared to the control group (estimated main effect of 2.53; P < .001; 95% CI, 1.8-3.2) and remained lower until 12 hours postoperatively (P < .001 from postanesthesia care unit admission to 4 hours postoperatively, .001 at 6 hours, .025 at 8 hours, and .043 at 12 hours). At 18 and 24 hours, visual analog scale pain scores were not significantly different between both groups (P = .634 and .432, respectively). Four patients in the erector spinae plane block group required intraoperative fentanyl compared to 27 patients in control group. The median (quartiles) of intraoperative fentanyl consumption in the erector spinae plane block group was significantly lower (0 µg [0-0 µg]) compared to that of the control group (94 µg [74-130 µg]). Ten patients in the erector spinae plane block group required postoperative rescue pethidine compared to 25 patients in control group. The median [quartiles] of postoperative rescue pethidine consumption was significantly lower in the erector spinae plane block group (0 mg [0-33 mg]) compared to that of the control group (83 mg [64-109 mg]). Time to first rescue analgesic request was significantly prolonged in the erector spinae plane block group compared to control group (P < .001). Ultrasound-guided bilateral erector spinae plane block provided lower postoperative visual analog scale pain scores and decreased consumption of both intraoperative fentanyl and postoperative rescue analgesia for patients undergoing open epigastric hernia repair.

Comparison of quadratus lumborum versus continuous epidural block for laparoscopic donor nephrectomy: analysis of postoperative analgesia and motoric ability

Pain management in post transperitoneal laparoscopic nephrectomy is a key to early recovery. Different types of regional anesthesia techniques have been applied for managing post-operative pain. However, the results are still not satisfactory. This study aims to compare effectiveness of ultrasound-guided bilateral Quadratus Lumborum (QL) block with continuous epidural analgesia in improving post transperitoneal laparoscopic nephrectomy analgesia and motoric mobility. This is a randomized controlled trial that included 26 healthy living kidney donor patients. All subjects were randomized to receive preoperatively bilateral QL block (n=13) or continuous epidural analgesia (n=13). Subjects in QL group received 20 mL of bupivacaine 0.25% bilaterally and subjects in epidural group received continuous bupivacaine 0.125% infusion 6 mL/hour. Numerical rating scale (NRS), Bromage score, and duration of urinary catheterization were recorded. The results presented no significant differences in NRS scores at rest and movement, and Bromage score between QL block group and epidural block group in at 2,6,12,24 hours after surgery. The QL block group received significantly lower total dose of bupivacaine (p<0.001) and duration of urinary catheterization was significantly shorter (p=0.001) compared to epidural group. This study found that QL block produced similar postoperative NRS and Bromage score with fewer dose of bupivacaine and shorter duration of urinary catheterization compared with continuous epidural analgesia within 24 hours.

Comparison of intraoperative hemodynamic stability between quadratus lumborum and epidural block in patients who underwent laparoscopic nephrectomy

Laparoscopic nephrectomy has become the standard procedure for living donor renal transplant in Indonesia. The anesthesia technique used for this procedure is general anesthesia combined with regional anesthesia. Among many techniques available, epidural block is often performed. This study aims to compare hemodynamic stability between Quadratus Lumborum (QL) block, as a new alternative block, and epidural block for laparoscopic nephrectomy. Patients were randomized to receive epidural block (n=13) or QL block (n=13) for intraoperative analgesia during laparoscopic nephrectomy. Patients in epidural group received continuous bupivacaine 0.25% infusion 6 ml/hours and patients in QL group received 20 ml of bupivacaine 0.25% bilaterally. Hemodynamic variables consisting of mean arterial pressure (MAP), heart rates (HR), as well as fentanyl consumption between the two groups were compared. There were significant differences in intraoperative MAP between epidural block group and QL block group (p = 0.001). However, there were no significant differences in HR (p = 0.114) and fentanyl consumption (p = 0.593) between two groups. QL block produced a relatively steadier MAP compared to epidural block; however intraoperative HR and fentanyl consumption between two groups had no significant difference.

Dural puncture epidural analgesia for labor: a randomized comparison between 25-gauge and 27-gauge pencil point spinal needles

BackgroundThis double-blind, randomized trial compared dural puncture epidural analgesia (DPEA) for labor using 25-gauge and 27-gauge pencil point spinal needles. We hypothesized that both needle sizes would result in similar...

126 The Role of a Multimodal Analgesic Protocol in Decreasing Use of Narcotics

The penile implant is an effective strategy for managing medication refractory erectile dysfunction. Despite the high patient and partner satisfaction rates1, post-operative pain can be significant. In an effort to manage pain, clinicians often resort to the use of opioid prescriptions However, the American opioid crisis has led physicians to seek alternative strategies for managing patient’s post-operative pain. A multimodal analgesic protocol consisting of acetaminophen, gabapentin, meloxicam, and local anesthetics, has been described in an effort to decrease narcotic usage while maintaining satisfactory pain control.2 The purpose of this study was to assess the efficacy of a multimodal analgesic protocol in decreasing narcotic usage following penile prosthesis This is a single-institution, single surgeon, retrospective review 55 primary three-piece penile prosthesis cases performed between September 2018 and November 18, 2018. All cases were placed through an infrapubic approach and performed on an outpatient basis. Prior to November 1st, 2018 patients were given an intraoperative dose of ketorolac if their renal function allowed and were subsequently discharged home with a prescription for Lortab and tramadol (20 pills each). Following November 1st, 2018 patient’s pain was managed according to a multimodal protocol as a described by Simhan et. al. Patients were given pre-operative acetaminophen, gabapentin, and meloxicam in the holding area 1 hour prior to surgery. An intraoperative local anesthetic pudendal nerve block was performed with 30 ml of bupivacaine and patients were discharged home with a prescription for Lortab (20 pills), gabapentin, and meloxicam. The main outcome measure was the number of post-operative phone calls for narcotic refills during the 30-day post-op period.

Comparison of IL-6 and CRP Concentration Between Quadratus Lumborum and Epidural Blockade Among Living Kidney Donors: A Randomized Controlled Trial

BackgroundAn adequate anesthesia technique generates appropriate postoperative analgesic properties and decreases the patient’s stress response. This will lead to decreased morbidity and mortality associated with immunology disturbances, such as infection, prolonged wound healing, and sepsis.ObjectivesThe aim of this study was to compare interleukin-6 (IL-6) and C-reactive protein (CRP) concentrations, as the markers of the stress response, between continuous epidural and quadratus lumborum (QL) block as postoperative analgesia techniques among living kidney donors.MethodsSixty-two patients were randomly divided into two equal groups: continuous epidural and QL block. A group received bilateral QL block with 20 mL of bupivacaine 0.25% and the other received 6 mL/hour of bupivacaine 0.25% continuously via an epidural catheter. Prior to extubation, the QL block group received bilateral QL block with the same dose and the continuous epidural group was administered with 6 mL/hour of bupivacaine 0.125%. Blood samples were drawn to compare IL-6 and CRP concentrations after intubation (preoperatively), directly after surgery, 24 hours postoperatively, and 48 hours postoperatively. Postoperative pain was measured with the numerical rating scale (NRS). Morphine requirement and duration of catheter usage were also measured postoperatively. Side effects within 24 hours postoperatively were noted. Data were analyzed with independent t-test or Mann-Whitney test.ResultsNo difference was observed between the groups in the plasma concentration of IL-6 either after surgery or 24 hours postoperatively (P = 0.785 and P = 0.361, respectively) although the mean IL-6 concentration 24 hours postoperatively was lower in the QL block group than in the continuous epidural group. CRP concentration was not significantly different between the groups either after surgery or 48 hours postoperatively (P = 0.805 and P = 0.636, respectively).ConclusionsThere was no significant difference in IL-6 and CRP concentrations between continuous epidural and QL block among living kidney donors. Both continuous epidural and QL block techniques showed comparable postoperative analgesic properties among living kidney donors undergoing laparoscopic nephrectomy.

Effects of Epidural Needle Rotation on Evolution of Unilateral Epidural Block and Patients' Hemodynamics beside Recovery Profile in Patients Undergoing Arthroscopic Knee Surgeries; A Randomized Clinical Trial.

Objective:To evaluate the evolution pattern of epidural block after rotating the needle tip 45° to the operative side and evaluate its effects on patients’ hemodynamics and recovery profile in those undergoing arthroscopic knee surgery.Methods:Forty participants were randomly subdivided into control and rotation group (n=20). An 18-gauge, 3.5 inch, Tuohy needle was placed at the level of L4-5 and pushed forward into the epidural space through parasagittal approach, in control group, the needle was pushed forward to the epidural space in cephaldad 90 degrees. For the rotation group, the needle was pushed forward to the epidural space and the tip was rotated 45 degrees to the surgical side.15 mL of bupivacaine 0.5% was injected and evolution of sensory and motor blocks until 2-segment regression of the sensory level below to T10 as well as total duration of motor block and surgery were recorded. Hemodynamic parameters (HR, MAP, and SPO2), hypotension, fluid intake, vasopressors, first ambulation and spontaneous urination were recorded. Statistical analysis was performed using SPSS and P≤0.5 considered significant.Results: Sensory block up to T10 level, Complete motor block and time for 2-segment regression of sensory level were earlier in the 45°-rotation than in the control group (p<0.001). Total duration of motor block in control group was lower than rotation group (p<0.001).Hypotension, N&V, vasopressors and fluid intake showed no statistically difference between the two groups (p=0.219). First spontaneous urination and ambulation were significantly lower in rotation group (p<0.001).Conclusion:45 degrees’ needle rotation to the surgical side provides a faster block evolution and hastened recovery profile with no significant difference in hemodynamic fluctuations.Clinical trial registry: IRCT20130518013364N7

Effect of Intraperitoneal Instillation of Bupivacaine on the Pain Scores post operation of Laparoscopic Cholecystectomy

Laparoscopic cholecystectomy is now an established form of treatment for patients with symptomatic gall stones as it is an excellent mean to minimize the trauma and agony of the patient following surgery, although recent studies have shown that patients still experience considerable pain after this surgery. In our current study, we aim to assess the effectiveness of intraperitoneal instillation of bupivacaine in the reduction of post-operative pain after laparoscopic cholecystectomy. 40 patients were randomly allocated in two groups; a study group that received 50 ml of bupivacaine (50%) instilled intraperitoneally into the gall bladder bed and under the surface of diaphragm, and control group which received 50 ml of 0.9% normal saline instilled in the same way. Data recorded from patients in pre-designed format and enrolled in a randomized double-blind prospective study showed a significant decline in post-operative pain scores in the study group between 1st and 4th hours as compared to the control group and, consequently, consumption of analgesics was lower in intergroup comparison. Discharge after surgery was significantly earlier in the study group (75%) one-day admission, while only (35%) of group B discharged after one-day hospitalization. We conclude that routinely intraperitoneal instillation of bupivacaine in laparoscopic cholecystectomy is a simple and safe method to minimize postoperative abdominal pain and analgesic requirements, which enhances early mobilization and discharge, and may become a routine practice.

Determination of the Optimal Programmed Intermittent Epidural Bolus Volume of Bupivacaine 0.0625% With Fentanyl 2 μg/mL at a Fixed Interval of 40 Minutes: A Biased Coin Up-and-down Sequential Allocation Trial

(Anaesthesia. 2018;73:459–465) The use of programmed intermittent epidural bolus (PIEB) to provide labor analgesia has been increasing in popularity as commercially available pumps have become available. A variety of dosing strategies have been evaluated but the optimal settings for PIEB have not yet been established. The majority of studies have included PIEB in conjunction with patient controlled epidural analgesia (PCEA). The current investigators had previously investigated which PIEB dosing strategy would minimize breakthrough pain and the need for PCEA boluses. They determined the optimal regimen was 10 mL of bupivacaine 0.0625% with fentanyl 2 µg/ml administered every 40 minutes. However, 34% of women exhibited a sensory block to ice above T6, which might indicate an unnecessarily high spread of local anesthetic. Therefore, they conducted this prospective, double-blind, dose-finding study to investigate whether it was possible to reduce the PIEB volume without compromising the efficacy of the technique.

Effect of Verapamil Adjuvant with Local Anaesthetic Mixtures in Supraclavicular Brachial Plexus Block

Among the various approaches to block brachial plexus , supraclavicular approach offers a high success rate for elbow, forearm and hand surgery . Various adjuvant drugs have been used with local anesthetics in order to decrease the time of onset and prolong the duration and quality of regional blocks. So efforts were made to combine the adjuvant with local anesthetics to improve patient and surgeon satisfaction. In this randomized study we tried to see the effect of verapamil in brachial plexus block as an adjuvant with local anaesthetic .This randomized study wasconducted in Anaesthesiology department of ShaheedZiaurRahman Medical College Hospital after approved by the ethical review board of this hospital.The study subject were divided into two groups (Group A=only local anaesthetics&amp;Group B=local anaesthetics with Verapamil) , 30 IN numbers in each group. Group-A patients was administered 15ml of 1% lignocaine with 15 ml of bupivacaine 0.25% while in Group-B patients was administered injection verapamil 3.5 ml (3.5 mg) in addition to the above mixture. In this study mean onset time of sensory block was 11.53 ± 1.4 minutes in group - A and 7.12 ± 1.68 minutes in group – B which is not statistically significant (p value = 0.057). The mean onset time of motor block in group A was 15.26 ± 1.96 min, and in group B was 11.58 ± 2.68 min and this difierence isstatistically significant (p value=0.000152). Duration of motor block was 96.30 min and 115.08 min in group A and Group B respectively. Sensory block was 157.26 min and 188.0 min in group A and Group B respectively. Regarding the heart rate, no significant difference was detected between the groups at the time of preanesthesia and at the 5 min after anaesthesia. Compared with group B patients, group A patients shows slight but statistically significant increased heart rate at the 10 min (80, 92 beat/min respectively) after brachial plexus block. At 30 minute after, mean systolic BP was 97.9±4.7 mmHg in group A and 84.3±5.0 mmHg in group B. At 45 minute after, mean systolic blood pressure was 94.6±15.6 mmHg and 84.3±5.0 mmHg in group A and group B respectively. At 60 minutes after, mean systolic blood pressure was 59.6±6.0 mmHg in group A and 61.2±9.4 mmHg in group B. At 15, 30 and 45 minute difference was statistically significant (p&lt;0.05) between two groups. In conclusion, the study revealed that verapamil can be used as an adjuvant to decrease the onset time of sensory and motor blocks of bupivacaine in supraclavicular block. Moreover, verapamil doses in regional blocks did not show any hemodynamic side effects.&#x0D; Bangladesh Med J. 2017 May; 46 (2): 43-47

Efficacy and Safety of Dexamethasone versus Fentanyl as an adjuvant with Bupivacaine and Lignocaine in Supraclavicular Brachial Plexus Block

Background: Brachial plexus blockade is gaining popularity day by day for the upper extremity surgery.Increasing the duration of local anesthetic action by adding different adjuvant is often desirable toprolong the surgical anesthesia and analgesia. The aim of this study was to make a comparative evaluationof the efficacy and safety of dexamethasone and fentanyl as an adjuvant with bupivacaine-lignocaine insupraclavicular block. Material and methods: This comparative study was carried out in the departmentof anesthesiology in Chittagong Medical College Hospital in collaboration with the department oforthopedic surgery over a period of 22months starting from July, 2012 to April, 2014. A total 130 adultpatients of either sex with American Society of Anesthesiology (ASA) health status I-II were selected forupper limb surgery under supraclavicular brachial plexus block was randomly allocated in to two groupsof 65 patients in each. Group- D was received dexamethasone 2ml (10mg) and Group-F was receivedfentanyl 2ml (100mg) in 38ml of bupivacaine and lignocaine with adrenaline (total volume of 40ml). Result: The mean onset of sensory&amp;motor block was 7.72±1.949min &amp; 8.75±2.008min in group-D and7.60±3.711min &amp; 9.23±5.114min in group-F. Both the results in two group was not statistically significant(p&gt;0.05).The duration of analgesia in group-D was 11.40±0.844hrs and in group-F was 8.62±1.747hrs.Theresults was significantly higher in group-D than group-F (p&lt;0.05). Conclusion: There was significantlyprolonged duration of analgesia and better onset of sensory and motor block in dexamethasone groupthan in fentanyl group without any unwanted effects. JBSA 2019; 32(1): 10-17

Efficacy and Safety of Fentanyl as An Adjuvant with Bupivacaine and Lignocaine in Supraclavicular Brachial Plexus Block

Background: Adding narcotics to local anesthetic is very effective in prolonging the analgesic effects. The aim of this study is to evaluation the efficacy and safety of fentanyl as an adjuvant with bupivacaine-lignocaine in supraclavicular block.&#x0D; Methods: This analytical study was carried out in the department of anesthesiology in Chittagong Medical College Hospital in collaboration with the department of orthopedic surgery over a period of 22 months starting from January 2012 to December 2014. A total 130 adult patients of either sex with American Society of Anesthesiology (ASA) health status I-II were selected for upper limb surgery under supraclavicular brachial plexus block was randomly allocated in to two groups of 65 patients in each. Group- C was received Distilled water 2ml and Group-F was received fentanyl 2ml (100 g) in 38ml of bupivacaine and lignocaine with adrenaline (Total volume of 40ml).&#x0D; Results: The mean onset of sensory &amp; motor block was 10.49±0.75 min &amp; 9.41±0.76 min in group-C and 7.60±3.711min &amp; 9.23±5.114min in group-F. The duration of analgesia in group-C was 3.81±0.88 hrs and in group-F was 8.62±1.747 hrs.&#x0D; Conclusion: There was significantly prolonged duration of analgesia and better onset of sensory and motor block in fentanyl group without any unwanted effects.&#x0D; Chatt Maa Shi Hosp Med Coll J; Vol.17 (2); Jul 2018; Page 31-35