Ml Of Hyperbaric Bupivacaine Research Articles

Haemodynamic Effects and Complications of Unilateral Spinal versus Standard Spinal Anesthesia in Elderly with Low Ejection Fraction Undergone Lower-Limb Surgery

Background: Cardiovascular system may be profoundly affected by spinal anaesthesia due to unavoidable sympathetic blockade which is more prominent in elderly.A restricted sympathetic block during spinal anesthesia may minimize hemodynamic changes.Objective: To assess whether a unilateral spinal anaesthesia using 0.5% hyperbaric bupivacaine will restrict the sympathetic block to avoid the undesired cardio vascular effects.Materials and method: In this prospective study 60 ASA Ill and IV patients aged between 60-90 years undergoing unilateral lower limb surgery were included. Patients were divided into two groups. In group-A, dural puncture was performed with the patient in the lateral decubitus position with 1.5 mL of hyperbaric bupivacaine. In group-B, it was performed with the patient in a seated position using 1.5 mL hyperbaric bupivacaine. Each patient was then placed in supine position. The speed of injection was 1 mL/30s. Patients were placed in the lateral position with operated side down and kept in this position for 10 minutes. Motor and sensory levels were assessed, and haemodynamic alterations were monitored just after block, 5, 10, 15 and 30 minutes of spinal anaesthesia.Results: The demographic data were found similar in both groups. The time to the onset of the sensory and motor block was significantly shorter in group-B. The duration of motor and sensory block was significantly shorter in group-A. Haemodynamically all the parameters revealed better out come in unilateral spinal anesthesia. The incidence of complications (nausea, headache, and hypotension) was also lower in group A.Conclusion: When unilateral spinal anesthesia was performed using a low-dose, low-volume and low-flow injection technique, it provides adequate sensory-motor block and helps to achieve stable hemodynamic parameters during surgery on a lower limb. Furthermore, this technique avoids unnecessary paralysis on the non-operated side.Delta Med Col J. Jan 2017 5(1): 20-24

Continuous spinal anesthesia for elderly patients with cardiomyopathy undergoing lower abdominal surgeries

BackgroundAnesthetic management, of patients with cardiomyopathy with reduced systolic function, is challenging and may be associated with high mortality. Continuous epidural anesthesia (CEA) is generally accepted as the routine method of regional anesthesia for vascular surgery of the lower limb.Continuous spinal anesthesia (CSA) has been reported to be more rapid in action, with good sensory and motor block, fewer hemodynamic disturbance and side effects when compared to continuous epidural anesthesia (CEA), and single dose spinal anesthesia (SDSA).Patients and methodsForty adult patients with depressed systolic function (EF 45% or less) scheduled for lower abdominal surgeries were subjected to our study. Under full aseptic precautions subarachnoid space was accessed in the setting position by an epidural needle at L3–4 and 2 ml of hyperbaric bupivacaine (10 mg) was injected into subarachnoid space, then an epidural catheter was inserted in the subarachnoid space for 3 cm. Anesthesia was maintained by Top up doses of plain bupivacaine 0.5% 1.2 ml.ResultThere were no differences in demographic characteristics of patients, procedure’s duration, and ASA physical status classification. There were no significant changes in hemodynamics throughout the procedure. Hypotension occurred in 5% of patients, bradycardia occurred in 10% of patients and arrhythmia occurred in 2.5% of patients. There were no postoperative ECG changes and postoperative Troponin was negative. There was no postoperative Neurological deficit or Post dural puncture headache.ConclusionWe can conclude that, CSA was effective and safe technique for patients with cardiomyopathy undergoing lower abdominal surgeries.

Abstract PR331

Background & Objectives: Total Knee Arthroplasty (TKA) is a common surgical procedure for patients with end stage joint disease [1]. Poorly controlled pain in the post-operative setting is associated with higher levels of opioid use and opioid related adverse effects, immobility, morbidity, longer hospital admissions, and decreased overall patient satisfaction [2]. There is no current gold standard for pain reduction in the post-operative time period. One narcotic alternative, intravenous acetaminophen, was first commercialized in Europe in 2002 and has subsequently been approved by the FDA. Preliminary studies have found it safe and efficacious for decreasing post-operative pain, including TKA. We plan to perform a three arm study comparing the clinical advantages of a periarticular liposomal bupivacaine injection versus a standardized knee injection cocktail previously described versus this same knee injection cocktail with the addition of intravenous acetaminophen on decreasing opioid related side effects without sacrificing expected levels of analgesia. The main study endpoints will be a Visual Analogue Score (VAS) Pain score and Opioid Related Symptoms Distress Scale (OR-SDS). Additional endpoints will include Total Morphine Equivalents (TME) administered, Actual Length of Stay, Active Knee Range of Motion, and Discharge location. Materials & Methods: This will be a randomized, prospective, single-center clinical trial to evaluate the efficacy of three treatment methods on reducing pain in patients undergoing a TKA. The study will involve 141 patients divided evenly into three treatment arms. All patients in this study will be treated with the standardized spinal anesthesia, the standardized adductor canal block, 10 mg of dexamethasone intravenously, and four postoperative doses of IV ketorolac (15 mg every eight hours for forty-eight hours). The Standardized Spinal Anesthesia After it is washed with epinephrine, between 1.4 ml to 2 ml of hyperbaric bupivacaine will be drawn into the syringe (with dosage dependent on the height of patient and duration of surgery). The Standardized Adductor Canal Block Periarticular Liposomal Bupivacaine Injection Treatment Group Standardized Knee Cocktail Treatment Group IV Acetaminophen Plus Standardized Knee Cocktail Treatment Group Results: The results of the 141 currently enrolled patients will be reported after statistical analysis. Conclusion: The result of the 141 currently enrolled patients will be reported after statistical analysis with conclusions to follow.

Efficacy of intrathecal dexmedetomidine in prevention of shivering in patients undergoing transurethral prostatectomy: A randomized controlled trial

BackgroundShivering is a frequent complication following spinal anesthesia (SA). It is more common in transurethral resection of the prostate (TURP) that may be due to absorption of large amount of irrigating fluids. We aimed to investigate the role of intrathecal dexmedetomidine in attenuation and prevention of shivering in patients undergoing TURP under SA.MethodsIn a randomized, controlled trial, eighty patients were scheduled for elective TURP under SA. Patients were randomly allocated into two groups: control group (group C): patients received 2.5 ml of hyperbaric bupivacaine 0.5% plus 0.5 ml of normal saline and dexmedetomidine group (group D); patients received 2.5 ml of hyperbaric bupivacaine 0.5%, plus 10 μg dexmedetomidine in 0.5 ml of normal saline. Hemodynamic parameters, shivering score and any adverse effects were recorded.ResultsThe incidence of shivering was significantly reduced in group D, 6/40 patients (15%) compared with 23/40 patients (57%) in group C (P < 0.001). The frequency of bradycardia, hypotension, number of patients treated with meperidine and ephedrine were significantly higher in group D compared with group C (P = 0.048, P = 0.043, P = 0.011, P = 0.043) respectively. There was insignificant difference in the incidence of nausea, vomiting and TUR syndrome in patients in both groups (p < 0.05).ConclusionOur results suggest that the use of 10 μg intrathecal dexmedetomidine in patients undergoing TURP has a noticeable control of shivering even in occurrence of tolerable side effects.

Regional anesthesia in transurethral resection of prostate (TURP) surgery: A comparative study between saddle block and subarachnoid block.

Background:Spinal anesthesia is the technique of choice in transurethral resection of prostate (TURP). The major complication of spinal technique is risk of hypotension. Saddle block paralyzed pelvic muscles and sacral nerve roots and hemodynamic derangement is less.Aims and objectives:To compare the hemodynamic changes and adequate surgical condition between saddle block and subarachnoid block for TURP.Material and methods:Ninety patients of aged between 50 to 70 years of ASA-PS I, II scheduled for TURP were randomly allocated into 2 groups of 45 in each group. Group A patients were received spinal (2 ml of hyperbaric bupivacaine) and Group B were received saddle block (2 ml of hyperbaric bupivacaine). Baseline systolic, diastolic and mean arterial pressure, heart rate, oxygen saturation were recorded and measured subsequently. The height of block was noted in both groups. Hypotension was corrected by administration of phenylephrine 50 mcg bolus and total requirement of vasopressor was noted. Complications (volume overload, TURP syndrome etc.) were noted.Results:Incidence of hypotension and vasopressor requirement was less (P < 0.01) in Gr B patients. Adequate surgical condition was achieved in both groups. There was no incidence of volume overload, TURP syndrome, and bladder perforation.Conclusion:TURP can be safely performed under saddle block without hypotension and less vasopressor requirement.

Hyperbaric spinal ropivacaine in lower limb and hip surgery: A comparison with hyperbaric bupivacaine.

Background and Aims:Bupivacaine is more cardiotoxic than ropivacaine. Ropivacaine provides effective spinal anesthesia for lower limb and hip surgeries. This prospective study was designed to compare the efficacy and safety of intrathecal hyperbaric ropivacaine with hyperbaric bupivacaine for patients undergoing limb and hip surgeries.Material and Methods:Two hundred patients aged 40-75 years, with American Society of Anesthesiologists I and II of either gender were randomly divided into Group R (Ropivacaine) and Group B (Bupivacaine) to receive an intrathecal injection of 3 ml of hyperbaric ropivacaine 0.5% or 3 ml of hyperbaric bupivacaine 0.5%, respectively. Onset and duration of sensory blockade were determined using the pinprick method by a three-point scale at T-10 dermatome. Onset and duration of motor block were assessed by modified Bromage scale. Duration of postoperative analgesia, hemodynamic changes, central nervous system and cardiovascular system toxicity or any adverse effects were observed.Results:The mean onset of sensory block (6 ± 1.3 min vs. 3 ± 1.1 min; P < 0.001) and motor block (13 ± 1.6 min vs. 9 ± 1.3 min; P < 0.05) was significantly slower in ropivacaine group as compared to bupivacaine group. The total duration of sensory block was significantly shorter in the ropivacaine group (160 ± 12.9 min) than in the bupivacaine group (260 ± 16.1 min; P < 0.05). The mean duration of motor block was also shorter in the ropivacaine group compared to bupivacaine group (126 ± 9.2 min vs. 174 ± 12.6 min; P < 0.05). Quality of anesthesia was comparable in two groups (P = 0.04).Conclusion:We conclude that hyperbaric bupivacaine used intrathecally has a faster onset of sensory block and prolonged duration of analgesia compared to hyperbaric ropivacaine.

Comparison of intrathecal hyperbaric bupivacaine and levobupivacaine for Cesarean section

Background Levobupivacaine is a relatively new amide local anesthetic, and it has been already investigated in epidural and locoregional techniques, but more has to be known regarding its characteristics in spinal anesthesia. Aims The aim of our study was to compare clinical and anesthetic features of levobupivacaine and racemic bupivacaine when intrathecally administered in patients undergoing elective Cesarean section. Patients and methods Hundred patients of ASA I and II were randomized to receive an intrathecal injection of one of two local anesthetic solutions. Each patient in group L ( n = 50) received 2 ml of isobaric levobupivacaine 5 mg/ml (10 mg) with 15 μg of fentanyl, whereas each patient in group B ( n = 50) received 2 ml of hyperbaric bupivacaine (10 mg) with 15 μg of fentanyl. The parameters studied were onset and total duration of sensory block, onset and total duration of motor block, the quality of intraoperative anesthesia, hemodynamic alterations, and any intraoperative and postoperative complications. Results There were no significant differences in demographic or surgical variables between the two groups. There was no significant difference in the quality of anesthesia and intraoperative side effects in the two groups. Time to complete regression of motor blockade was statistically lower in group L (135 ± 15.6 vs. 145 ± 20.5 min; P 12 level in group L (168.3 ± 15.6 vs. 172.2 ± 20.5 min; P > 0.005) was nonsignificant when compared with group B. Conclusion Levobupivacaine, the pure S (-) enantiomer of racemic bupivacaine, is an equally effective local anesthetic for spinal anesthesia for Cesarean section, compared with racemic bupivacaine.

English

OBJECTIVE: Spinal Anesthesia is the most preferred technique of anesthesia for lower segment caesarean section which provides effective pain relief during intraoperative and initial postoperative period. Various intrathecal adjuvant for postoperative pain relief have been tried which provide suboptimal analgesia and various side effects on maternal and fetus. We planned to assess the duration of analgesia by comparing intrathecal hyperbaric bupivacaine with preservative free ketamine and hyperbaric bupivacaine alone in parturient undergoing caesarean section. METHODS: A prospective, randomized, controlled study was conducted on 100 pregnant patients belonging to ASA I & II scheduled for LSCS under spinal anesthesia. Study comprised of two groups of 50 patients each. The first group received 2 ml of Hyperbaric Bupivacaine 0.5%+25 mg Preservative free Ketamine while group II received 2 ml of Hyperbaric Bupivacaine 0.5%. RESULTS: The mean duration of postoperative analgesia was160± 0.6minutes in group I and 120±0.7minutes in group II, P value <0.001. Incidence of hypotension and bradycardia was less in group I as compared to that of group II. Apgar score was statistically insignificant in both the groups. CONCLUSIONS: Addition of 25mg preservative free ketamine to hyperbaric bupivacaine in spinal anesthesia for LSCS significantly prolongs the duration of postoperative analgesia with better intraoperative hemodynamically stability and without any adverse effect on neonates.

English

BACKGROUND: Hemodynamic disturbance and uteroplacental hypoperfusion can occur due to Aortocaval Compression (ACC) in parturient which are further aggravated by SAB. Incidence of maternal hypotension due to cephalad spread of local anesthetic (LA) in subarachnoid space and ACC by gravid uterus; both these factors influenced by parturient's posture during and immediately after SAB, we tested the hypothesis that keeping parturient in sitting position for five minutes after SAB, likely limit the spread of LA, thus reduce the incidence of hypotension and Intraoperative ephedrine requirements. AIMS AND OBJECTIVES: to determine the effects of making parturient sit up for five minutes after SAB, that would have on sensory block height, incidence of hypotension and ephedrine requirements. Secondarily, to study duration of postoperative analgesia. MATERIALS AND METHODS; Single blinded randomized comparative study having 30 parturients in each group CS and CL were allocated to receive 2ml of hyperbaric bupivacaine with 0.4ml NS, Or 20 µgm fentanyl added to 2 ml hyperbaric bupivacaine group FS or FL, either in sitting group (made to sit for 5 min. post SAB before supine) or in lying group, made supine immediately. The maximum level of sensory blockade achieved and monitoring of heart rate, noninvasive blood pressure, respiratory rate and oxygen saturation were done every 2 min for first 10 min then at 15 min interval for remainder of operation. Postoperatively, onset of pain was noted. STATISTICAL ANALYSIS: By using descriptive and inferential statistics using unpaired t-test, chi Square test, and Mann-Whitney U test. The Software used was SPSS 17.0 version and Graph Pad Prism 5.0. Analyzed data was expressed as mean ± SD for continuous variables and number (%) for categorical variables. P value < 0.05 was considered statistically significant RESULTS: Sitting Groups had lower sensory block height than lying Groups; also required less ephedrine. Duration of postoperative analgesia was prolonged in both the fentanyl Groups. CONCLUSION: prolonged sitting position after spinal anesthesia not only limit the spread of LA, producing lower sensory block height but also reduces the incidence of

English

BACKGROUND: Preferred technique of anesthesia for caesarean section is spinal anesthesia and the commonest complication of this technique is hypotension. Because hypotension is associated with increased morbidity and mortality in the fetus as well as in the mother, several modalities have been recommended to bring down its incidence. Volume preloading 15-20min before spinal anesthesia is commonly practiced one. Among the different fluids available, commonly used for preloading are crystalloids and colloids. Many studies have been done to evaluate the efficacy of different fluids for preloading. Many investigators have found that colloids are superior to crystalloids for preloading. In this context, this study was designed to test the hypothesis that colloid preloading is associated with less hypotension than crystalloid preloading. AIM: To compare the efficacy of RL with Pentastarch 6% as preloading fluid in prevention of spinal induced hypotension in caesarean section patients. METHODOLOGY: Two groups, group I and group II comprising of 30 parturients each, belonging to ASA I and ASA II coming for elective caesarean section under spinal anesthesia were selected. Parturients in group I were preloaded with 1L of Ringer's lactate solution whereas those in group II were preloaded with 500 ml of Pentastarch 6% solution. After institution of spinal anesthesia with 2 ml-2.2ml of hyperbaric Bupivacaine using 25G Quincke's needle, patient's blood pressure and other vital parameters were monitored intraoperatively every 2 min for first 20 min and then every 5 min till the end of surgery and results were subjected to statistical analysis. RESULTS AND CONCLUSION: Parturients who were preloaded with Pentastarch 6% had less hypotension than those preloaded with RL. We concluded that colloids are better preloading agents than crystalloids for control of spinal induced hypotension in caesarean section patients.

Intrathecal Dexmedetomidine as Adjuvant for Bupivacaine in Subarachnoid Block for Lower Abdominal and Lower Limb surgeries

Context Spinal Anaesthesia is the most common anaesthetic technique used for lower abdominal and lower limb surgeries. Dexmedetomidine is a selective alpha agonist which is known to prolong the action of local anaesthetics when administered as an intravenous infusion or when administered 2 intrathecally.Aims To investigate the effect of intrathecal administration of dexmedetomidine on sensory motor block and haemodynamic parameters.Settings and Design Prospective Randomised Controlled Double Blind study. Methods and Material 100 patients were randomly allocated to two groups. Patients in Group N received 2ml of hyperbaric bupivacaine 1 ml normal saline and Group D received 2 ml of hyperbaric bupivacaine 5 mug dexmedetomidine in 1 ml normal saline.Statistical analysis used Paired Ttest Independent T test Chi square testResults Duration of sensory blockade was significantly prolonged in Group D 317.2plusmn 90.27 minutes when compared to Group N 204.26plusmn 84.77 minutes. The median cephalad level of sensory block achieved was T7 range -T5-T10 in group D and in group N it was T9 range - T6-T12. The regression of motor blockade to Bromage score 0 was significantly prolonged in Group D 323.14plusmn93.43 in comparison to Group N 206.98plusmn 88.Conclusion Intrathecal dexmedetomidine is an effective adjuvant and prolongs the duration of motor and sensory blockade with minimal side effects.

Sinus arrest with intrathecal dexmedetomidine.

Sir, Dexmedetomidine, a highly selective α2 adrenoceptor agonist, is being increasingly used as an adjuvant in neuraxial blocks as it prolongs the sensory and motor block in a dose-dependent manner.[1] Severe bradycardia and cardiac arrest has been reported with the intravenous use of dexmedetomidine.[23] However, severe bradycardia progressing to sinus arrest after intrathecal administration of dexmedetomidine has not been reported. A 40-year-old female, 155 cm in height and weighing 65 kg, was scheduled for total abdominal hysterectomy. She had been operated for myomectomy under spinal anaesthesia 5 years back. Her general physical examination and all routine investigations were unremarkable. Upon arrival in the operating room, monitors were attached and her vitals were recorded. A peripheral venous access was established and pre-loaded with 500 mL of Ringer lactate. The subarachnoid space was reached in the L2-L3 interspace using a 25G Quincke's needle with the patient in the left lateral position. After ensuring free flow of cerebrospinal fluid, 2.5 mL of hyperbaric bupivacaine with 10 μg of dexmedetomidine was administered. The patient was positioned supine and oxygen was administered via a face mask at a rate of 5 L/min. The level of sensory block to pinprick was T10 after 2 min, and T6 was the highest level of sensory block achieved. The surgery commenced and the patient's heart rate remained in the range of 50-60/min, with the blood pressure at around 130/80 mmHg. After about 70 min, when the surgeons were suturing the peritoneum, there was a sudden drop in her heart rate to 40/min. Immediately, the surgical handling was stopped and injection atropine 0.6 mg was given intravenously, to which there was no response for 3 min. Meanwhile, she complained of some discomfort in her epigastrium and her heart rate further dropped to 34/min while her blood pressure was 124/76 mmHg with SpO2 of 99%. Another dose of inj. atropine 0.6 mg was given intravenously but her heart rate dropped to 18/min over 5 s followed by sinus arrest. Then, the third dose of inj. atropine 0.6 mg was given, which led to an increase in her heart rate to 86/min. The level of sensory blockade was T10 at this time and the SpO2 was consistently 99%. The surgery was completed in the next 15 min uneventfully and the estimated blood loss was around 200 mL. The patient remained comfortable with a heart rate of around 74/min and blood pressure of 124/86 mmHg. Her post-operative Holter monitoring and echocardiography were unremarkable. Intrathecal dexmedetomidine when combined with spinal bupivacaine produces earlier onset and prolonged duration of sensory and motor block with excellent quality of post-operative analgesia without significant haemodynamic alterations.[14] Although episodes of sinus arrest and severe bradycardia progressing to asystole have been reported in patients receiving intravenous dexmedetomidine,[23] no severe cardiovascular complications have been observed with intrathecal dexmedetomidine. Two cases of bradycardia (heart rate 50/min) have been observed by Gupta et al. when they used 5 μg of dexmedetomidine as an intrathecal adjuvant for post-operative analgesia.[5] The two very unusual features observed in our case were the time to the occurrence of sinus arrest and the high dose of atropine required for its treatment. As 1 h had elapsed between the intrathecal administration of drugs and the sinus arrest, sinus arrest due to sympathetic blockade due to bupivacaine was less likely. The level of sensory block had also receded to T10 by that time. We therefore speculate that a centrally mediated decrease in sympathetic outflow and increase in parasympathetic outflow due to dexmedetomidine may be the cause. The patient's autonomic response to peritoneal stretching could also be a contributing factor responsible for the severe bradycardia in this case. However, the bradycardia did not respond to the cessation of surgical handling and the usual dose of atropine. A fall in blood pressure and heart rate has been reported with various interventions like displacement of liver, insertion of hand into the peritoneal cavity, placement of packing and retraction of the wound edges. A vagally mediated reflex has been implicated in most cases, but exact pathways have not been established so far.[6] To conclude, although dexmedetomidine is an attractive intrathecal adjuvant for post-operative analgesia, we recommend meticulous use of this drug with vigilant monitoring in the operating room as well as in the post-anaesthesia care unit keeping in mind the possibility of delayed occurrence of severe bradycardia.

Thoracic spinal anesthesia is safe for patients undergoing abdominal cancer surgery.

Aim:A double-blinded randomized controlled study to compare discharge time and patient satisfaction between two groups of patients submitted to open surgeries for abdominal malignancies using segmental thoracic spinal or general anesthesia.Background:Open surgeries for abdominal malignancy are usually done under general anesthesia, but many patients with major medical problems sometimes can’t tolerate such anesthesia. Regional anesthesia namely segmental thoracic spinal anesthesia may be beneficial in such patients.Materials and Methods:A total of 60 patients classified according to American Society of Anesthesiology (ASA) as class II or III undergoing surgeries for abdominal malignancy, like colonic or gastric carcinoma, divided into two groups, 30 patients each. Group G, received general anesthesia, Group S received a segmental (T9-T10 injection) thoracic spinal anesthesia with intrathecal injection of 2 ml of hyperbaric bupivacaine 0.5% (10 mg) and 20 ug fentanyl citrate. Intraoperative monitoring, postoperative pain, complications, recovery time, and patient satisfaction at follow-up were compared between the two groups.Results:Spinal anesthesia was performed easily in all 30 patients, although two patients complained of paraesthesiae, which responded to slight needle withdrawal. No patient required conversion to general anesthesia, six patients required midazolam for anxiety and six patients required phenylephrine and atropine for hypotension and bradycardia, recovery was uneventful and without sequelae. The two groups were comparable with respect to gender, age, weight, height, body mass index, ASA classification, preoperative oxygen saturation and preoperative respiratory rate and operative time.Conclusion:This preliminary study has shown that segmental thoracic spinal anesthesia can be used successfully and effectively for open surgeries for abdominal malignancies by experienced anesthetists. It showed shorter postanesthesia care unit stay, better postoperative pain relief and patient satisfaction than general anesthesia.

A comparative evaluation of hyperbaric ropivacaine versus hyperbaric bupivacaine for elective surgery under spinal anesthesia.

Background:Recently introduced ropivacaine is 40% less potent than bupivacaine. Ropivacaine made hyperbaric by the addition of dextrose is known to provide reliable spinal anesthesia (SA). This study was designed to compare the clinical efficacy of equal doses of hyperbaric 0.5% ropivacaine with 0.5% bupivacaine for SA.Materials and Methods:Eighty American Society of Anesthesiologists grade I-II patients undergoing elective infraumbilical surgeries under SA were recruited and randomized to receive 3ml of hyperbaric ropivacaine 5mg/ml containing dextrose 83 mg/ml (by the addition of desired dose of 25% dextrose) in Group R or 3ml of hyperbaric bupivacaine 5mg/ml containing dextrose 80 mg/ml in Group B. Monitoring of vitals and observation for the block parameters were carried out. The data were presented as mean with a standard deviation and frequency with percentage. Statistical analysis was performed using InStat computer software with appropriate tests and P < 0.05 was considered to be significant.Results:Ropivacaine produced a slower onset of sensory block (ropivacaine 4.5 min; bupivacaine 3.2 min; P < 0.05) and the mean total duration of sensory block was significantly lesser (ropivacaine155 min; bupivacaine 190.5 min; P < 0.05). Patients in the ropivacaine Group R had significantly more rapid recovery from the motor blockade (ropivacaine120 min; bupivacaine 190 min; P < 0.05) and passed urine sooner than the patients in bupivacaine Group B (ropivacaine 257 min; bupivacaine 358 min; P < 0.05).Conclusion:Ropivacaine 15 mg in dextrose 8.3% provides reliable SA of shorter duration than bupivacaine 15 mg in 8% dextrose.

Comparision of Intrathecal Fentanyl and Intravenous Ondansetron for Prevention of Nausea -Vomiting during Cesarean Delivery with Spinal Anaesthesia

This study compares intrathecal fentanyl with IV ondansetron for preventing intraoperative nausea and vomiting during cesarean deliveries performed with spinal anesthesia. One twenty healthy parturients posted for elective caesarean section under spinal anaesthesia using hyperbaric 0.5% bupivacaine were randomly allocated into two groups of sixty each. Group-F received 12.5μg of fentanyl intrathecally along with 2 ml of hyperbaric bupivacaine. Group-O received 4 mg of intravenous ondansetron. Intraoperatively, an anaesthesiologist blinded to the study recorded the presence or absence of nausea, retching and vomiting. The frequencies for nausea, retching and vomiting were compared using test of proportion for the two samples. The level of significance was taken as 0.05. The incidence of nausea, retching and vomiting in fentanyl group is 11.67%, 5% and 3.33% respectively where as in ondansetron group the incidence is 26.67%, 20% and 18.33%. There is significant difference between two groups with the P values 0.037, 0.013 and 0.08 for nausea, retching and vomiting respectively. Intrathecal fentanyl as part of a spinal anesthetic for cesarean delivery is superior to IV ondansetron for the prevention of intraoperative nausea and vomiting.

Effects of intrathecal bupivacaine–fentanyl versus bupivacaine–dexmedetomidine in diabetic surgical patients

BackgroundDiabetes mellitus is the most common endocrine disorder encountered during anesthesia. Experimental researches showed that the functional μ opioid receptors in the dorsal horn of spinal cord in diabetics are either reduced or impaired in their function. This prospective study was postulated to differentiate between the effects of either opioid like fentanyl versus nonopioid like dexmedetomidine agents added to spinal bupivacaine in diabetic patients.MethodsSixty diabetic patients of either sex were submitted for elective lower limb orthopedic surgery. Patients were randomly allocated into three equal groups (each group 20 patient): bupivacaine group in which patients received 2.5 ml of hyperbaric bupivacaine 0.5% plus 0.5 mL of normal saline, bupivacaine–fentanyl group in which patients received 2.5 ml of hyperbaric bupivacaine 0.5% plus 25 μg fentanyl in 0.5 mL of normal saline and bupivacaine–dexmedetomidine group in which patients received 2.5 ml of hyperbaric bupivacaine 0.5%, plus 10 μg dexmedetomidine in 0.5 mL of normal saline. Duration and quality of sensory and motor block were assessed.ResultsThe duration of sensory and motor block as well as duration of effective analgesia was significantly longer in the bupivacaine–dexmedetomidine group as compared with both bupivacaine–fentanyl and control bupivacaine groups.ConclusionAddition of intrathecal dexmedetomidine to heavy bupivacaine 0.5% was more advantageous than fentanyl with special regard to its analgesic properties in diabetic surgical patients.

Transient aphasia following spinal anaesthesia in an orthopaedic patient

A 50-year-old male [American Society of Anesthesiologists (ASA) grade II] was scheduled for lower limb orthopaedic surgery. The subarachnoid space was localised with difficulty at L3/4 interspace and 3 ml of hyperbaric bupivacaine was given. Within a few minutes, the patient developed aphasia with a very high sensory block extending to C2 dermatome, followed by apnoea. The patient remained haemodynamically stable throughout surgery and respiration resumed within five minutes. Inadvertent subdural deposition of local anaesthetic was speculated to be the cause of this unusual presentation.

Comparison of intrathecal bupivacaine-fentanyl and bupivacaine-butorphanol mixtures for lower limb orthopedic procedures.

Context:Intrathecal use of butorphanol is less explored in human subjects.Aims:To compare the safety and efficacy of anesthesia and analgesia of intrathecal bupivacaine-butorphanol mixture with intrathecal bupivacaine-fentanyl mixture.Settings and Design:Tertiary level, teaching hospital. Prospective, randomized, double-blind studyMaterials and Methods:Eighty patients aged above 18 years, of ASA physical status 1 or 2, undergoing lower limb orthopedic surgeries were randomly allocated to two groups of 40 patients each. Patients in group A and group B received intrathecal 2.5 ml of hyperbaric bupivacaine (0.5%), with 25 μg of fentanyl and 25 μg of butorphanol, respectively.Statistical Analysis Used:Fisher's exact test and Chi square testsResults:The times required for onset of sensory and motor blockade were comparable among the two groups. Significantly slower block regression to S2 level was observed in the group receiving intrathecal butorphanol as compared to intrathecal fentanyl (P=0.0230). A higher number of patients in group A requested for rescue analgesia during the postoperative period than in group B (9 versus 2; P=0.0238). The average times to first request for rescue analgesia were 308.6±14.9 minutes and 365.9±12.3 minutes in group A and B, respectively (P=0.0254).Conclusions:Both 25 μg fentanyl and 25 μg butorphanol given intrathecally along with 12.5 mg of hyperbaric bupivacaine provide effective anesthesia for lower limb surgeries. Intrathecal bupivacaine-butorphanol mixture provides longer duration of sensory blockade and superior analgesia than intrathecal fentanyl-bupivacaine mixture.

Effect of Intravenous Ondansetron on Sensory and Motor Block after Spinal Anaesthesia with Hyperbaric Bupivacaine

Ondansetron is a potent antiemetic and a competitive antagonist at serotonin receptors, which are also involved in modulation of pain. This study was designed to assess the effect of systemic ondansetron on sensory and motor block after subarachnoid anaesthesia with hyperbaric bupivacaine. Sixty patients undergoing transurethral resection of bladder tumours were randomly assigned to one of two groups. Group 1 received 2 ml (4 mg) of ondansetron whereas patients in group 2 received 2 ml of normal saline 15 minutes prior to administration of subarachnoid block with 2.5 ml of hyperbaric bupivacaine 0.5%. Time to attain peak sensory block (P = 0.27), time to two segment regression (P = 0.19) and time to regression to the S, dermatome (P = 0.84) did not significantly differ between the two groups. No differences in regression of sensory block were noted at any time. The mean duration of motor block also did not differ (P = 0.44), with similar regression of block at all time intervals except at 90 minutes. We concluded that intravenous ondansetron does not affect the intensity or duration of sensory and motor block after spinal anaesthesia with hyperbaric bupivacaine.

A comparison of intraarticular morphine and bupivacaine for pain control and outpatient status after an arthroscopic knee surgery under a low dose of spinal anaesthesia

Effective pain control is important after an outpatient arthroscopic knee surgery to permit early discharge and improve outcome. The aim of this study was to compare intraarticular morphine and bupivacaine with placebo for postoperative pain control and outpatient status after a knee arthroscopic surgery under a low dose of spinal anaesthesia. After obtaining the ethic committee's approval and written informed consents from 60 adult outpatients undergoing knee arthroscopy, patients were enrolled in this prospective, randomized, double-blinded, placebo-controlled clinical study. All patients received spinal anaesthesia with 1.4 ml of hyperbaric bupivacaine 0.5%. Patients were randomly divided into three groups as morphine (group M, n =20), bupivacaine (group B, n = 20), and placebo (group C, n = 20). After the surgical procedure, patients received one of the following solutions intraarticularly in a double-blinded randomized manner: 5 mg morphine in 20 ml saline, 20 ml 0.25% bupivacaine, or 20 ml saline. Postoperative pain was assessed using a 10-cm visual analogue scale (VAS). Patient characteristics, hemodynamic values, sensory and motor blocks, VAS values, rescue analgesics, discharge time, and patient satisfaction were recorded. There were no significant differences in patient characteristics, surgery and tourniquet time, hemodynamic values, and sensory and motor blocks. The VAS values at 30, 60, and 90 min were similar among the three groups. The VAS values at rest and during move were higher in group C than in groups M and B at 120, 150, 180 min, and 24 h (P < 0.001). There was no difference in VAS values between the groups M and B. Rescue analgesics used and discharge time were significantly different in the placebo group when compared to groups M and B (P < 0.001). Side effects were similar among the groups. Patient satisfaction scores were high in the groups M and B. Administration of 5 mg morphine and 20 ml of 0.25% bupivacaine intraarticularly provides better pain relief and shorter discharge time without increasing the side effects than placebo for an outpatient arthroscopic knee surgery performed under a low dose of spinal anaesthesia.