Onset Of Motor Blockade Research Articles

Infraclavicular versus supraclavicular nerve block for upper limb surgeries: A meta-analysis.

The impact of infraclavicular versus supraclavicular nerve block on the analgesia for upper limb surgeries is unclear. This meta-analysis and systematic review aims to study the analgesic efficacy of infraclavicular versus supraclavicular nerve block for upper limb surgeries. We searched several databases including PubMed, EMbase, Web of science, EBSCO and Cochrane library databases from inception to December 2023, and randomized controlled trials (RCTs) assessing the effect of infraclavicular versus supraclavicular nerve block for upper limb surgeries were included. We excluded studies reporting other nerve block approaches. The methodological quality of the included studies was evaluated by the modified Jadad scale. Standard mean difference with 95% confidence interval (CI) was used to assess continuous outcomes. This meta-analysis was conducted by the fixed-effect model or random-effect model based on the heterogeneity. Eight RCTs and 725 patients were included in this meta-analysis. Compared with supraclavicular nerve block for upper limb surgeries, infraclavicular nerve block was able to significantly increase duration of motor block (SMD = 0.34; 95% CI = 0.12 to 0.56) and decrease readiness for surgery (SMD = -0.43; 95% CI = -0.77 to -0.10), but showed similar duration of sensory block (SMD = 0.17; 95% CI = -0.05 to 0.39), block performance time (SMD = -0.14; 95% CI = -0.51 to 0.22), onset of sensory blockade (SMD = -0.13; 95% CI = -0.59 to 0.33) and onset of motor blockade (SMD = -0.17; 95% CI = -0.26 to 0.12). No high heterogeneity was seen among the included studies. Infraclavicular nerve block may be superior to control the analgesia for upper limb surgeries than supraclavicular nerve block.

A Comparative Study between Ultrasound-guided Concomitant Infraclavicular Plus Distal Median, Radial, and Ulnar Nerve Blockade Versus Infraclavicular Block Alone

Abstract Background: Peripheral nerve blocks can be used alone as the sole “surgical” anesthetic technique as the initial step in providing prolonged postoperative analgesia. There are studies, where accurate deposition of local anesthetic perineurally has the potential to improve the success rate and reduce the incidence of complications of the infraclavicular block. We hypothesized whether a combined block of the infraclavicular brachial plexus and distal median, radial, and ulnar nerves would accelerate upper extremity anesthesia compared with an infraclavicular block alone. Materials and Methods: This study was a prospective randomized control study conducted among 60 patients undergoing elective and emergency wrist and hand surgeries. A group of 30 patients received an infraclavicular block with 30 mL of a local anesthetic mixture containing 1% lignocaine with adrenaline and 0.25% bupivacaine from Group A. Group B received an infraclavicular block with 15 mL of local anesthetic mixture containing 1% lignocaine with adrenaline and 0.25% bupivacaine along with distal median, radial, and ulnar nerve blockade with 5 mL each of local anesthetic mixture containing 1% lignocaine with adrenaline and 0.25% bupivacaine. Pain score, assessment of sensory and motor functions, block performance time, and surgical anesthesia were observed. Results: The mean block performance time of Group A was 10.9 ± 1.1 min and Group B was 14.7 ± 0.5 min. The difference between the two groups’ block performance minutes was statistically significant (P < 0.001). The difference in the onset of the sensory block between the two groups was statistically significant (P < 0.001). The mean onset of motor blockade between the two groups was statistically very highly significant (P < 0.001). The mean of Group A was 5.0 ± 0.2 and Group B was 2.1 ± 0.4. Conclusion: From this study, we conclude that using an approximately equivalent dose of local anesthetics, combining ultrasound-guided infraclavicular block with distal median, radial, and ulnar nerve blockade shortens the onset time of sensory and motor block with improved block consistency compared to infraclavicular block alone.

Comparison of the Analgesic Duration Using Ultrasound-guided Popliteal Sciatic Nerve Block between Diabetics with Neuropathy and Nondiabetics without Neuropathy.

In India, the prevalence of diabetes mellitus neuropathy was reported to be as high as 30%. Eight percentage of the diabetic population suffer from foot ulceration and 1.8% have amputations. Popliteal nerve block can be potentially used for foot and ankle surgery with several advantages. To compare analgesic duration of an ultrasound (US)-guided popliteal sciatic nerve block between diabetics with neuropathy and nondiabetics without neuropathy. Participants were allocated into two groups for popliteal sciatic nerve blocks under US guidance. The primary outcome was the duration to onset of sensory and motor blockade. The secondary outcome was the duration to rescue analgesic and the visual analog scale scoring within 24 h. Hemodynamic outcomes were also monitored along with the above variables. It was observed that the onset of sensory blockade was faster in participants with diabetes mellitus with peripheral neuropathy as compared to the nondiabetic participants and the duration for onset of motor blockade in dorsiflexion was faster in diabetic patients as compared to the nondiabetic patients (17.48 ± 3.21 min). However, there was no significant changes when comparing the onset of duration to loss of plantar flexion, in diabetics (17.86 ± 2.29 min) versus in nondiabetics (18.51 ± 3.32 min). The duration for rescue analgesics was found to be longer in diabetic participants (13.19 ± 2.14 h) as compared to the nondiabetic participants (11.44 ± 1.86 h). No differences were observed in the hemodynamic changes and the complications associated with local anesthetics in either group. Diabetic patients with neuropathy have faster onset of blockade when compared to nondiabetic patients without neuropathy which may be due to the degenerative condition of the peripheral nerves in them. The hemodynamic parameters do not play a role in defining the outcome of the block.

Supraclavicular Brachial Plexus Block with and without Dexamethasone as Local Anaesthetics

Background: Brachial plexus block is good alternative to general anesthesia for upper limb surgery. This avoids the unwanted effect of anesthetic drugs used during general anesthesia and the stress of upper airway instrumentation. Peripheral nerve blocks can be used for anesthesia, postoperative analgesia, diagnosis and treatment of chronic pain disorders. This study was carried out to compare onset and duration of sensory and motor blockade and duration of postoperative analgesia on addition of dexamethasone to local anestheic and local anesthetic alone in supraclavicular brachial plexus block. Methods: In this prospective randomized, controlled, double blinded study which was conducted at Department of Anesthesia, 250 Beded Hospital, Lalmonirhat, Rangpur, Bangladesh from January to June 2023. We included 70 ASA I & II patients who were aged between 18 years & 60 years, underwent elective upper limb surgeries. They were divided into two equal groups. Group 1 (cases) who received 15 milliliter of 2% lignocaine with adrenaline and 15 milliliter of 0.5% bupivacaine + dexamethasone 8mg (2ml). Group 2 (controls) who received 15 milliliter of 2% lignocaine with adrenaline and 15 milliliter of 0.5% bupivacaine + 0.9% normal saline (2ml). We observed the Onset of sensory and motor blockade, duration of sensory and motor blockade and postoperative analgesia between the two groups. Results: In this study of patients according to their age and weight. 37.26±15.55 years were mean age in group 1 and in group 2 it was 36.56±16.86 with p value being 0.8678. 58.466± 3.9642 kg was the mean weight in group 1 and in group 2 it was 60.4±4.95 kg with p value of 0.1002. So both the groups were comparable in terms of age and weight. In this study out of 70 patients, group1 consisted of 68.6% males whereas there were 60% in group 2 and group 1consisted of 31.4% of females and 40% in group2, hence males’ outnumbered females in both the groups. The mean duration of surgery in group 1 was 50±19.95 minutes and in group 2 were 46.6±15.55 minutes with p value of 0.4646. There was no statistical difference between both the groups. The onset of sensory blockade was within 7.3 min in group 1. In group 2 the onset of sensory blockade was 13.66 minutes. The onset of motor blockade was within 3.93 min in group 1. In group 2 the onset of motor blockade was 18.66 min. The duration of intra operative analgesia was 654.33 minutes in group 1. In group 2 the duration of intra operative analgesia was 292.6 minutes. The duration of post-operative analgesia was 815±13.57 minutes in group 1. The duration of post-operative analgesia in group 2 was 393.8±42.88 minutes. There were no complications in both the groups in intra operative period and post-operative period. Conclusion: Dexamethasone, when added to 15 millilitre of 0.5% bupivacaine and 15 millilitre of 2% lignocaine plus adrenaline, very effectively enhances the onset of sensory and motor blockade. It dramatically prolongs the duration of sensory and motor blockade and duration of analgesia. There were no untoward side effects with the use of dexamethasone as an additive in the brachial plexus block.

Comparative Study of Injection Butorphanol Versus Injection Fentanyl with Injection Ropivacaine in Ultrasound Guided Supraclavicular Block to Evaluate Sensory and Motor Block Characteristics

BACKGROUND Regional anaesthetic technique has many advantages over general anesthesia. The supraclavicular brachial plexus block due to its rapid onset and reliability offers dense anesthesia of brachial plexus for surgeries at or distal to elbow. The additives like injection Fentanyl and injection Butorphanol along with 0.5% injection Bupivacaine have been proved to be efficient for supraclavicular block. However their effects haven't been compared by using them as additives in 0.5% Injection Ropivacaine. Aims To compare the sensory and motor block characteristics of injection Butorphanol and injection Fentanyl in injection Ropivacaine. METHODS This prospective single blinded randomised control study included 60 patients (ASA I or II; 18- 60 yrs) scheduled for upper limb surgeries. Patients were randomly allocated to two groups of 30 each and supraclavicular block was given as per distribution (Group B: 30 ml 0.5 % injection Ropivacaine with 2mg injection Butorphanol and Group F: 30 ml 0.5 % injection Ropivacaine with 100 mcg injection Fentanyl). The hemodynamic parameters were recorded at baseline, post block and till 45 mins. Sensory and motor block assessments were done along with sedation score determination. Duration of sensory and motor block was noted. RESULTS The group with injection Fentanyl as additive had earlier onset of motor blockade. Time required to achieve sensory blockade was less in Group F. Duration of sensory and motor block prolonged in Group F. CONCLUSIONS Injection Fentanyl as additive in injection Ropivacaine provided earlier onset of motor block and decreased total time required to achieve maximum sensory block with prolonged duration and decreased requirements of rescue analgesia.

STUDY OF COMPARISON BETWEEN BUPIVACAINE 0.5% & ROPIVACAINE 0.5%IN ULTRASOUND GUIDED AXILLARY BRACHIAL PLEXUS FOR ELECTIVE UPPER LIMB SURGERIES

Background: This study contains comparison between Bupivacaine 0.5% &Ropivacaine 0.5% in ultrasound guided axillary brachial plexus block in elective upper limb surgeries. It is safer technique compared to GA .Study aims comparison of both local anaesthetic drugs in terms of volume , onset of motor & sensory blockade, duration of motor & sensory blockade & duration of analgesia. Methods: This randomized, controlled, double blinded study at tertiary care center compared effect of bupivacaine 0.5% and ropivacaine 0.5%. Adults meeting specific inclusion criteria were divided in 2 equal groups 30 patients in each. All patients were given USG guided axillary block. Group A received Inj. Bupivacaine 0.5% 2.5-3 mg/kg (20-30 ml) while group B received Inj. Ropivacaine 0.5% 2-3 mg/kg (20-30 ml). Outcome measured included volume of drug, onset of motor & sensory blockade, duration of motor & sensory blockade. Hemodynamic parameters, VAS score, requirement of rescue analgesic (VAS >4) observed during perioperative period at different intervals. Sensory & motor block were assessed by 3-point scale.VAS score is evaluated by asking the patients to describe their pain between 0 to 10. p-value ≤0.05was considered statistically significant. Results: Comparison between both groups showed that onset of motor blockade (11.3 ±1.48 min ) & sensory blockade (7.46 ± 1.40 min ) was slower in group A , whereas onset of motor blockade (6.91± 1.39 min) & sensory blockade (3.13 ± 0.84 min) was faster in group B. While duration of motor blockade (681.16 ± 15.23 min) & sensory blockade (745 ± 25.12 min) was prolonged in group A compared to shorter duration of motor blockade (480.83 ± 31.67 min ) & sensory blockade (550.16 ± 39.62 min ) in group B. Duration of Analgesia was longer in group A(1388.83 ± 162.85 min ) compared with group B (856.16 ± 139.51 min ). Conclusion: Ropivacaine 0.5% is associated with faster recovery of sensory & motor function with better safety profile compared to Bupivacaine 0.5%.

Comparison of the effect of intrathecal fentanyl citrate and magnesium sulfate as adjuvants to hyperbaric levobupivacaine 0.5% for spinal anesthesia in patients undergoing lower limb orthopedic surgeries

Background: Subarachnoid blockade is a safe, reliable, and inexpensive technique that provides surgical anesthesia along with prolonged post-operative analgesia. The quality of subarachnoid block is enhanced by the addition of intrathecal adjuvants, such as fentanyl citrate and magnesium sulfate to hyperbaric levobupivacaine. Aims and Objectives: The aim of this study was to compare the effects of fentanyl and magnesium sulfate as adjuvants to 0.5% hyperbaric levobupivacaine in orthopedic surgeries under subarachnoid block. Materials and Methods: This prospective randomized study included 90 American Society of Anesthesiologists Grade I and II patients aged 18–60 years undergoing orthopedic surgeries. Group LS received 3 mL 0.5% levobupivacaine heavy+0.5 mL normal saline. Group LF received 3 mL 0.5% levobupivacaine heavy+fentanyl 25 μg, and Group LM, 3 mL 0.5% levobupivacaine heavy+magnesium sulphate 50 mg+0.4 mL normal saline. The onset and duration of sensory and motor block and intraoperative hemodynamics were recorded. In the post-operative period, duration of analgesia, Visual Analog Scales scores, and side effects were observed. Results: The onset of sensory block was 4.04±0.74 min in Group LM (P<0.001) as compared to Groups LF (2.01±0.23 min) and LS (2±0.24 min). The onset of motor blockade took 5±1.14 min in the control group, 7.01±0.94 in group LF, and 8.11±1.33 min in group LM (P<0.001). The duration of analgesia in group LS was 183.73±12.08 min, 317±18.6 min in group LF, and 219.43±20.89 in group LM (P<0.001). Conclusion: The addition of fentanyl and magnesium as adjuvants enhanced the quality of subarachnoid block when added to hyperbaric levobupivacaine. The duration of analgesia was longest in fentanyl, followed by magnesium and then control. The incidence of side effects was greatest in fentanyl, followed by control and nil in magnesium.

A Prospective, Randomized, Comparative Study between Dexmedetomidine and Buprenorphine as an Adjuvant to Ropivacaine in Ultrasound-guided Supraclavicular Brachial Plexus Block for Upper Limb Orthopaedic Surgeries

Introduction: Supraclavicular approaches serve as a common method for administering regional anesthesia in upper limb procedures. In improving the impact with a length of pain relief, medical professionals frequently include additional substances such as dexmedetomidine, buprenorphine, dexamethasone, clonidine, sodium bicarbonate, and tramadol alongside local anesthetics. The intent of this study was to evaluate its impact of incorporating buprenorphine and dexmedetomidine into ropivacaine 0.5%. Materials and Methods: The trial of 90 patients between the ages of 18 and 60, who were identified as American Society of Anesthesiologists Grade 1 and 2, and scheduled upper limb surgery using the supraclavicular approach, were included. They were assigned into distinct groups, each of the groups consisting of thirty individuals. Group R was administered anesthesia consisting of 25 ml of ropivacaine 0.5% along with 1 ml of saline. Group B was administered anesthetics containing ropivacaine 0.5% and buprenorphine, which was diluted in saline. Group D was administered a solution containing ropivacaine 0.5% and dexmedetomidine, which was diluted in saline. Results: Group D had an earlier sensory blockade onset (8.25 min) compared to Group B (9.64 min) and Group R (12.89 min). Group D demonstrated a notably quicker motor blockade onset (9.21 min) in contrast to Group B (12.07 min) and Group R (15.03 min). In contrast with the other groups, Group D exhibited a more longer time frame of both sensory and motor blockades and also an extended period of anesthesia after the surgery. Conclusion: Dexmedetomidine was a more effective adjuvant over buprenorphine in the brachial plexus blocks. This resulted in significantly lower postoperative pain scores at 407.67 min and 612.32 min for the plain ropivacaine and buprenorphine groups, respectively.

Comparison of nalbuphine and morphine as intrathecal adjuvant to 0.5% bupivacaine for post-operative analgesia in lower abdominal surgeries – A randomized and control study

Background: The use of a higher volume of 0.5% bupivacaine, however, is associated with hemodynamic instability. Adjuvants such as morphine and other opioids are added in with the local anesthetic to reduce this adverse effect and extend the duration of sensory block, hence extending the length of analgesia. However, opiates are associated with a high risk of respiratory depression and other side effects. Nalbuphine has been used to counteract these adverse effects. Thus, we decided to compare the analgesic effect of intrathecal (IT) nalbuphine with IT morphine. Aims and Objectives: The aim of the study was to compare IT morphine with nalbuphine as adjuvant to a spinal anesthetic agent. The primary objective was to compare between the time of onset of sensory and motor blockade and the post-operative analgesic duration between the two adjuvants, while hemodynamic variables and side effects were studied as secondary variables. Materials and Methods: This randomized controlled study was conducted after Ethical Committee approval for a period of 1 year on 100 patients who fulfilled the inclusion criteria. They were randomized into two groups to receive sub-arachnoid block: Group A: 3 mL of 0.5% Hyperbaric Bupivacaine and 0.2 mg morphine and Group B:3 mL of 0.5% Hyperbaric Bupivacaine and 0.5 mg nalbuphine. The following parameters were monitored – Height, Weight, blood pressure, American Society of Anesthesiologists grading, time of onset, maximum duration and regression of Motor and sensory blocks, and total duration of analgesia. Results: The onset of sensory blockade was comparable in both groups while the onset of motor blockade was significantly longer in the morphine group (P≤0.001). The duration of analgesia in the morphine group was longer as compared to nalbuphine group and was statistically significant (P<0.05). The incidence of side effects was 26% in the morphine group and 6% in the nalbuphine group, which was statistically significant (P<0.05). Fourteen patients in the morphine group had pruritus and four patients in the nalbuphine group experienced nausea. Conclusion: IT nalbuphine with 0.5% bupivacaine produces rapid onset of anesthesia and early post-operative analgesia with minimal side effects, but the total analgesic duration was more with IT morphine.

Comparative study between 0.5% bupivacaine versus 0.5% ropivacaine in peribulbar anesthesia for cataract surgery

Background: For intraocular surgery, the optimal local anesthetic agent must have a rapid onset of action and a sufficient duration of effect so as to enable a painless, motionless procedure without prolonging akinesia. Aims and Objective: This prospective, comparative observational study compares ropivacaine and 0.5% bupivacaine for cataract surgery peribulbar block. Hyaluronidase is utilized in both groups because it promotes local anesthetic diffusion. Material and Methods: Present prospective, observational, comparative study performed at the Department of Anesthesia Tertiary Care Teaching Institute of India for the duration of 1 year. All eligible patients were allocated in two groups as GROUP B and GROUP R. GROUP B: 10 mL of 0.5% bupivacaine and 15 I.U./mL of hyaluronidase. GROUP R: 10 mL of 0.5% ropivacaine and 15 I.U./mL of hyaluronidase. Patients were assessed for sensory block, eyelid, and ocular movements at an interval of 2 min, and Visual Analog Scale score for pain assessment. Results: Age and gender did not differ significantly between the two study groups, according to the findings. Comparable and similar patient characteristics distinguished the two study groups. (P>0.05). The difference in onset of eyelid motor blockade between the two groups was not statistically significant. The difference in the onset of motor blockade [ocular movement] between the two groups was not statistically significant (P>0.05). (P>0.05) Analgesia duration differed significantly between the two groups in a statistical sense. Ropivacaine exhibits a significantly prolonged duration of analgesic effect than bupivacaine (P≤0.05). Conclusion: Peribulbar block utilizing 0.5% ropivacaine is a more favorable and secure option for a local anesthetic that effectively extends postoperative pain alleviation, in comparison to the use of 0.5% bupivacaine.

COMPARISON OF EPIDURAL VOLUME EXTENSION USING 2% LIGNOCAINE WITH STANDARD EPIDURAL VOLUME EXTENSION TECHNIQUE FOR HYSTERECTOMY UNDER COMBINED SPINAL EPIDURAL ANESTHESIA

Objectives: We compared epidural volume extension (EVE) using 2% Xylocaine with standard EVE technique and studied characteristics of neuraxial block along with hemodynamic stability and recovery profile in total abdominal hysterectomy surgery under combined spinal-epidural (CSE) anesthesia. Methods: 50 patients undergoing hysterectomy were randomly assigned into two groups. Group M (EVE with 2% 10 mL lignocaine) and Group C (EVE with 10 mL NS). Patients were anesthetized using CSE with 0.75% hyperbaric ropivacaine 2.5 mL and EVE, as per drug assigned to group. Anesthesia was maintained with epidural top-up with 2% lignocaine in 6 mL aliquot. Conscious sedation was provided. Perioperative data and recovery profile were recorded. Results: The amount of epidural anesthesia required to maintain block was less in Group M (17.7±4.5 mL in comparison to 26.9±7.3 mL in Group C p<0.001). Time for first epidural top-up required was early in Group C (62.1±26.2 min) than in Group M (83.718±.3 min). Onset of motor blockade was earlier in Group M (8.4±4.8 min). Quality of anesthesia was better in Group M. Pain and recovery from neuraxial block was earlier in Group C (31.02±13 min) in comparison to 49.88±12.01 min in Group M. Safe level of block was achieved without affecting cardiorespiratory function in all patients. Conclusion: CSE with modified EVE is a feasible technique, is associated with early onset of neuraxial block, and had longer time of two-segment regression with the need of less anesthesia drugs.

Comparative Study of Ropivacaine Alone Versus Combination of Ropivacaine with Either Dexmedetomidine or Dexamethasone for Ultrasound Guided Supraclavicular Brachial Plexus Block

Background: Ropivacaine is a common choice for supraclavicular brachial plexus block. Dexmedetomidine and Dexamethasone are frequently added to local anesthetics for improved effects. With limited comparative evidence, this study aimed to assess Dexmedetomidine and Dexamethasone as adjuvants to Ropivacaine in ultrasound-guided supraclavicular brachial plexus block.Methods: This prospective double-blind study enrolled patients aged 18-60, scheduled for elective upper limb surgery below mid-humeral level. They were randomly assigned into three groups: Ropivacaine alone, Ropivacaine with Dexmedetomidine (1 mcg/kg), or Ropivacaine with Dexamethasone (8 mg). The study aimed to compare sensory and motor blockade onset and duration, postoperative analgesia duration, and adverse event occurrence among the groups.Results: Ninety-eight patients participated in the study. All three groups showed similar characteristics in terms of age, weight, gender, ASA grade, and surgery duration. The onset and duration of sensory and motor block were comparable between the Dexamethasone and Dexmedetomidine groups. A significant difference was observed when comparing the Ropivacaine only group to either of the other two groups or when comparing all three groups. Similarly, postoperative analgesia duration was comparable between the Dexamethasone and Dexmedetomidine groups while it differed significantly when comparing all three groups or when comparing the Ropivacaine only group to either of the other groups. Ropivacaine with Dexmedetomidine group experienced notable occurrence of bradycardia.Conclusion: Dexamethasone and Dexmedetomidine as adjuvants to 0.5% Ropivacaine for ultrasound-guided supraclavicular brachial plexus blockade have comparable effects on sensory and motor blockade onset and duration, along with postoperative analgesia duration. Dexmedetomidine, however, is linked to more bradycardia compared to Dexamethasone.

A COMPARATIVE STUDY BETWEEN 0.5% LEVOBUPIVACAINE AND 0.75% ROPIVACAINE IN PATIENTS UNDERGOING ELECTIVE LOWER LIMB SURGERIES UNDER SUBARACHNOID BLOCK

Objective: The aim of the study was to compare the efficacy of 0.5% levobupivacaine and 0.75% ropivacaine after intrathecal administration in elective lower limb surgeries. Methods: A prospective, randomized, controlled, and double-blind study was conducted on 100 patients undergoing elective lower limb surgeries under subarachnoid block using 0.5% levobupivacaine and 0.75% ropivacaine. Results: Demographic characteristics of both groups are comparable. It is observed the onset of sensory blockade is earlier in ropivacaine group, Grade 4 bromage scale motor blockade onset is shorter in levobupivacaine and most of the parameters are comparable between two groups. Duration of sensory blockade is more in ropivacaine when compared to levobupivacaine. Levobupivacaine is more cardiostable with stable hemodynamic profile compared to ropivacaine. Conclusion: Levobupivacaine is more cardiostable with stable hemodynamic profile compared to ropivacaine.

Levobupivacaine versus ropivacaine in patients undergoing lower abdominal surgeries

Regional anesthesia, like Peripheral nerve block, is commonly used for peripheral surgeries to reduce severe intraoperative and postoperative pain relief. .Some studies with levobupivacaine have shown that duration of analgesia of levobupivacaine are longer compared to that of an equivalent dose of bupivacaine or ropivacaine.This study is done to compare efficacy and safety of levobupivacaine with ropivacaine. In this study we tried to compare efficacy and clinical characteristics of isobaric forms of intrathecal levobupivacaine 0.5% and ropivacaine 0.75% in lower abdominal surgeries.This prospective, observational and open labeled, comparative study done for a period of one year in a tertiary care health centre, in South India, prior approval from Institutional ethics committee was taken. 60 patients were included and each of 60 patients was randomized (sealed, numbered and opaque envelopes) to one of two groups of 30 patients. Each of the patients enrolled in the study received one of two solutions: levobupivacaine or Ropivacaine, patient was turned supine immediately after injection, time of which was defined as ‘zero’. Thereafter, investigator, assessed upper and lower limits of sensory block (analgesia to pinprick), degree of motor block and recorded heart rate and arterial pressure. The patients were then transferred into the operating theatre and assessments were continued at 30 min intervals thereafter until complete motor and sensory blocks regression. Data were analysed using a standard computer-based statistics package.Mean time of onset of sensory blockade for levobupivacaine was 3.85±0.5 min and in Ropivacaine was 3.90 ± 0.6 min. Mean time of onset of motor blockade in levobupivacaine group was 3.65 ± 0.72 min and in Ropivacaine group was 3.82 ± 0.88 min, mean duration of motor blockade in Levobupivacaine group was 201.15±22.06 min and in Ropivacaine group was 204 ± 21.20 min. Mean time for regression for levobupivacaine was 98.27±10.18 min and for ropivacaine was 96.33 ±8.21min. There is no significant difference, Mean time for first request of analgesic for Levobupivacaine was 262.22 ±36.60 and for Ropivacaine was 261.20 ± 32.71 min. There is no statistically significant difference; there was no statistically significant difference in the incidence of adverse events in both the groups. So both the drugs are considered to be safe in spinal anesthesia.In conclusion, Ropivacaine and Levobupivacaine has similar onset of sensory and motor blockade with comparable hemodynamic parameters and time for rescue analgesic administration was comparable between two groups and incidence of post- operative complications is not significant with both drugs.

TO COMPARE DEXMEDETOMIDINE WITH CLONIDINE AS ADJUVANTS TO ROPIVACAINE IN EPIDURAL ANESTHESIA IN PATIENTS UNDERGOING LOWER ABDOMINAL SURGERIES

Objective: The objective of the study is to compare dexmedetomidine with clonidine as adjuvants to ropivacaine in epidural anesthesia in the onset of sensory and motor blockade, duration of post-operative analgesia, level of sedation, and occurrence of side effects. Methods: This study was a prospective randomized observational and comparative study. Sixty patients of age between 20 and 50 years with the American Society of Anesthesiologists grade I and II physical status belonging to both sexes undergoing abdominal surgeries under epidural anesthesia are included; patients were allocated randomly into two groups comprising 30 patients in each group. Group A patients are given injection dexmedetomidine, added to ropivacaine and Group B patients are given injection clonidine, added to ropivacaine by epidural route. Following parameters were observed intra and post-operatively: Onset of sensory and motor blockade and duration of motor blockade, level of sedation, duration of analgesia, and side effects. All data are presented in tabular form as mean ± standard deviation. The analysis is done by unpaired t-test. Statistical analysis is done using SPSS software. Results: Mean time of onset of sensory blockade in Group A was 9.50 min with standard deviation of 1.85 and in Group B was 9.48 min with standard deviation of 1.60. Mean time of onset of motor blockade in Group A was 20.66 min with standard deviation of 2.83 and in Group B was 20.48 min with standard deviation of 2.52. Mean duration of analgesia in Group A was 312.66 min with standard deviation of 22.02 and in Group B was 314.20 min with standard deviation of 24.58. There is no statistical difference between two groups in the level of sedation which was assessed by Wilson’s sedation scale. Side effects most commonly observed are hypotension and bradycardia. Conclusion: We conclude that both dexmedetomidine and clonidine are similar in efficacy and tolerability as adjuvants in the onset of sensory and motor blockade and post-operative analgesia when added to ropivacaine in epidural anesthesia.

Evaluation of efficacy of peribulbar block with the combination of 2% lidocaine and 0.5% bupivacaine in comparison with 2% lidocaine and 0.75% ropivacaine in cataract surgery.

Cataract surgery is performed under peribulbar or retrobulbar block. Majority of the patients posted for cataract have some form of medical diseases like diabetes, hypertension, angina, ischaemic heart disease etc. Lidocaine and bupivacaine are the most commonly used local anesthetic for the block procedure. Here we compare the efficacy of peribulbar block in cataract surgery using the combination of 1:1 mixture of 2% lidocaine with 0.5% bupivacaine and 1:1 mixture of 2% lidocaine with 0.75% ropivacaine. It is a prospective, randomized, double blinded study including 60 patients were devided into two groups of 30 each, Group-R received 8 ml of 1:1 mixture of 4 ml of 2% lidocaine, 4 ml of 0.75% ropivacaine and 15 IU/ml of hyaluronidase and group-B received 8 ml of 1:1 mixture of 4 ml of 2% lidocaine, 4 ml of 0. 5% bubivacaineand 15 IU/ml of hyaluronidase. Peribulbar block was performed as per Bloomberg's modification of the Davis and Mandel technique where 5 ml of local anesthetic was injected in the infero temporal region and 3 ml of drug was injected in the superi nasal area. Patients were assessed for sensory block, eyelid and occular movements at an interval of 2 minutes. Systolic, diastolic and mean arterial pressures, heart rate, oxygen saturation, ECG were monitored non invasively at 1,3,5,8,10,15 and then every 10 minutes till the end of the surgery. Mean time for the onset of sensory blockade was 2.70 ± 6.5 minutes in Group B and 2.63 ± 0.57 minutes in group R with P-value 0.671, showing no significant difference in the onset of sensory blockade. Onset of motor blockade was 6.53 ± 1.81 minutes in group B, and 7.57 ± 1.46 minutes in the group R, the P-value being 0.018 was statistically significant. Regarding the duration of analgesia, our study showed mean time for analgesia lasted for 295 ± 54.63 minutes in group B and 414.67 ± 99.47 in group R with P value 0.001 showing statistically significant prolongation of duration of analgesia with group R. We observed a significant increase of mean IOP in bupivacaine group from 13.333 ± 1.582 mm Hg to 21.966 ± 2.697 mm Hg, whereas in ropivacaine group it increased from 12.766 ± 1.222 mm Hg to 13.0 ± 1.341 mm Hg after peribulbar anaesthesia.

Effect of Addition of Magnesium Sulphate to Fentanyl and Hyperbaric Bupivacaine in Spinal Anaesthesia for Abdominal Hysterectomy: A Randomised Clinical Study

Introduction: Subarachnoid block is the most acceptable and popular mode of anaesthesia for gynaecological surgeries. Addition of opioids to intrathecal bupivacaine is routinely practised. Magnesium sulphate (MgSo4 ), when used intrathecally has an advantage in preventing central sensitisation to peripheral nociceptive pain because it is an N-Methyl-DAspartate Receptor (NMDA) antagonist. Aim: To find out the efficacy of MgSO4 as intrathecal additive to combination of fentanyl and hyperbaric bupivacaine in prolonging duration of analgesia. Materials and Methods: This randomised clinical study was done between June 2022 to November 2022 in women of American Society of Anaesthesiologists (ASA) grade I and II aged 50 to 70 years scheduled for abdominal hysterectomy under spinal anaesthesia. They were randomly divided into two groups of 30 each (group ‘S’ and group ‘M’). Group ‘S’ received spinal anaesthesia with 3 mL (15 mg) of hyperbaric bupivacaine, 0.5 mL (25 µg) of Fentanyl and 0.1 mL of 0.9% normal saline while group ‘M’ received 3 mL of hyperbaric bupivacaine, 0.5 mL (25 µg) of Fentanyl and 0.1 mL (50 mg) of 50% MgSO4 intrathecally. End points of observation were time for onset of sensory and motor block and duration of analgesia. Data was entered in Microsoft Excel using Statistical Package for Social Sciences (SPSS) version 25.0. Results: Demographic profile was comparable between both the groups. Delay in onset of sensory block was observed in group ‘M’ (9±0.68 minutes) compared to group ‘S’ (4.88±0.47 minutes) (p<0.001). Similarly, onset of motor blockade too was delayed in group ‘M’ (11.92±0.71 minutes) compared to group ‘S’ (6.83±0.65 minutes) (p<0.001). Postoperative analgesia was significantly prolonged in group ‘M’ (262±8.3 minutes) compared to group ‘S’ (235±12.3 minutes) with a p-value of <0.001. Haemodynamic profile and side-effects showed no significant difference between both the groups. Conclusion: Addition of MgSO4 (50 mg) to combination of fentanyl and hyperbaric bupivacaine when given intrathecally prolongs the duration of spinal analgesia significantly in patients undergoing abdominal hysterectomy without significant side-effects.

Ntrathecal Hyperbaric Bupivacaine 0.5% with Varying Dose of Buprenorphine in Elective Adult Lower Limb Orthopaedic Surgeries: A Randomised Control Study

Introduction: Postoperative pain is a universal phenomenon and usually under treated and its intensity varies widely among patients. Spinal anaesthesia with opioid and local anaesthetics to prolong postoperative analgesia is common practice in recent years. Buprenorphine is an agonist - antagonist opioid. Intrathecal buprenorphine (30-150 µg) along with local anaesthetics is safe and known to increase the postoperative analgesia without affecting sensory or motor blockade and with lesser side effects. Aim: To compare the anaesthetic characteristics and its side effects in subarachnoid block with bupivacaine 0.5% heavy and varying dose of buprenorphine (90 µg and 120 µg). Materials and Methods: This randomised control study was conducted in the Jhalawar Medical College, Jhalawar, Rajasthan, India, from March 2019 to November 2019. The study included 90 patients belonging to American Society of Anaesthesiologists (ASA) class I and II of either sex age between 18 to 60 years posted for elective lower limb orthopaedic surgeries.The patients were divided into three groups; group A which included a patient count of 30 received plain hyperbaric bupivacaine 0.5% (2.5mL) with 0.5 mL saline. Group B which included 30 patients, receive plain hyperbaric bupivacaine 0.5% (2.5 mL) along with buprenorphine 90 µg diluted in 0.5 mL saline. Group C with a patient count of 30 received hyperbaric bupivacaine 0.5% (2.5 mL) with buprenorphine 120 µg mixed with 0.5 mL saline. Analgesic characteristics, haemodynamic parameters, side effects, sedation scores by Ramsay sedation score and pain scores by Visual Analogue Score (VAS) (0-10) were measured postoperatively till 24 hours.Statistical analyses of data were done by one Way Analysis of Variance (ANOVA) test and chisquare test where p-value less than 0.05 was considered to be a statistically significant value. Results: The onset time of sensory blockade (group A: 5.14±1.34, group B: 4.54±1.10, group C: 4.50±1.18 in minutes), time of onset of motor blockade (group A: 10.10±1.00, group B: 9.43±1.30, group C: 9.21±1.49 in minutes) and maximum level of sensory block at T6 level (group A: n-01/30, group B: n-04/30, group C: n-04/30) were comparable between the three groups and were not statistically significant. Sensory recovery time was significantly (p<0.0001) delayed in group B and C (178.9±7.18 min and 189.23±7.4), while in group A it was 152.86±8.9 min. Duration of postoperative analgesia was significantly (p<0.0001) prolonged in group C (group A 165.53±8.5, group B 391.49±19.8, group C 493.23±18 in minutes). Side-effects like Postoperative Nausea and Vomiting (PONV) and sedation were increased with dose of buprenorphine but easily treatable and not significant (p>0.05). Conclusion: A higher dose of buprenorphine shows to provide an adequate and longer postoperative analgesia without any major side effects.

Analgesia with bupivacaine under subarachnoid block in patients undergoing lower abdominal surgeries

Background and Aim: To study and compare the hemodynamic stability and duration of analgesia in spinal anaesthesia among bolus versus lower fractional doses of bupivacaine in the arachnoid block for the patients undergoing lower abdominal surgeries specifically urologic, pelvic, and lower limb surgeries. Methods: Interventional Randomized Comparative case-control study done among 70 study participants to compare analgesia with bupivacaine under subarachnoid block in patients undergoing lower abdominal surgeries. Results: To sum up, we found that the time for onset of the sensory block with a fractionated dose of bupivacaine in spinal anesthesia was significantly lesser than the time taken with a bolus dose and took a significantly longer time to regress. Conclusion: We found that patients who received a fractionated dose of bupivacaine had a faster onset of motor blockade compared

Comparative study between intrathecal bupivacaine versus intrathecal bupivacaine and fentanyl in elective caesarean sections

Background: Intrathecal administration of adjuvant drugs have been used increasingly for increasing the onset, duration and quality of analgesia. This study was designed to compare the efficacy of intrathecal hyperbaric bupivacaine with that of intrathecal hyperbaric bupivacaine with fentanyl for patients undergoing elective caesarean sections. Materials & methods: 50 aged between 15 to 30 years, whose weight is 45 to 80 kg, belonging to ASA class I and II, scheduled for elective caesarean sections were selected and randomized into 2 groups. Group B received 9mg of hyperbaric bupivacaine 0.5% and group BF received 9mg of hyperbaric bupivacaine 0.5% with 10mcg of fentanyl. The onset of analgesia, onset of motor blockade, the duration of sensory blockade, the duration motor blockade, the quality of blockade, duration of analgesia, Intrathecal Injection to delivery time, APGAR SCORE of neonates, hemodynamic parameters of parturient and side effects were recorded. Results: There was significant difference between the two groups in the meantime to onset of sensory anaesthesia (group BF 3.28±0.73mins, group B 3.84±1.06mins; p value=0.009). The onset of motor blockade was similar in both the groups. Excellent block was achieved in 80% patients in group B compared to 100% of patients in group BF.