Onset Of Sensory Block Research Articles

Quadratus Lumborum Block versus Transversus Abdominis Plane Block for Postoperative Pain Management after Total Abdominal Hysterectomy

Background: Post-operative analgesia is of vital importance to prevent various undesirable side effects such as respiratory complications, venous thromboembolism, and increased hospital stay. The transversus abdominis plane (TAP) block and Quadratus lumborum (QL) block has been used for post-operative pain relief in various abdominal surgeries as part of the multimodal analgesic approach. Therefore, this randomized, prospective study was conducted to compare the post-operative analgesic efficacy of QL block and TAP block in patients undergoing abdominal hysterectomy.Methods: This study was carried out in the Department of Anaesthesia, Analgesia, Palliative & Intensive Care Medicine, Dhaka Medical College Hospital, Dhaka. Patients of ASA status I and II, planned for total abdominal hysterectomy under spinal anaesthesia were selected and randomly allocated into two groups (Group A – TAP Block and Group B – QL Block). Hemodynamic status, time of onset of sensory block, mean duration of postoperative analgesia, the amount of rescue analgesic requirements as well as intensity of post-operative pain were assessed at different point of time. Visual analog scale (VAS) was used to assess the postoperative pain. Total morphine consumption in 24 hours and time required for 1st postoperative analgesic were recorded.Results: A total of 60 patients were included in this study. The onset of sensory block was faster in Group B than A (22.6±6.5 min & 16.3±5.2 min). VAS score was higher among group A at 10th hours and 18th hours. In case of group B, VAS score was more at 14th hour. Post operatively 1st demand of analgesia was earlier in Group-A (10.4±1.5 vs 14.1±1.7) (p< 0.001). Total analgesic requirement was higher in Group- A than Group B (18.7±4.6 vs11.2±3.8) (p< 0.001).Conclusion: Quadratus Lumborum Block produces longer duration of analgesia, provides optimum post-operative pain control and maintain an excellent hemodynamics than TAP block in patients undergoing abdominal hysterectomy.

A Comparative Study of the Efficacy of Intrathecal Injection of Hyperbaric Bupivacaine with Fentanyl Versus Hyperbaric Bupivacaine with Dexmedetomidine in Lower Abdominal Surgeries: A Prospective Randomized Study

Background: Spinal anaesthesia is the most common technique used for lower abdominal surgeries. Spinal anaesthesia using plain hyperbaric bupivacaine has disadvantages like delayed onset, shorter duration etc. Adding adjuvants like fentanyl, dexmedetomidine has overcome these disadvantages and improve post operative analgesia and stable hemodynamic condition with minimal side effects. Aim of the study was to determine the time of onset and duration of sensory and motor block, sedation score and postoperative analgesic efficacy of Fentanyl and Dexmedetomidine as adjuvant to bupivacaine in lower abdominal surgeries.
 Methods: This prospective, double blind, randomized study included total 100 patient-divided equally in 2 groups (group F-fentanyl and group D-dexmedetomidine) after matching the inclusion and exclusion criteria. Group F received 3ml of 0.5 % injection Hyperbaric Bupivacaine + 25 mcg Fentanyl and Group D received 3ml of 0.5 % injection Hyperbaric Bupivacaine + 5mcg Dexmedetomidine intrathecally. The onset and duration of sensory and motor block, sedation score, duration of postoperative analgesia and need of rescue analgesia along with haemodynamic parameters were recorded.
 Results: The mean time for onset of sensory block in group D was (3.5 ± 0.88 mins) significantly lower than group F (4.4 ± 1.2 mins) (p=0.001). And the mean time of onset of motor block in group D (3.23 ± 1.0mins) was significantly lower than in group F (4.3 ± 1.1 mins). Duration of sensory and motor block was significantly higher in group D as compared to group F. The mean analgesic dose in group D was 1.4 ± 0.78 and in group F was 3.6 ± 0.73(p<0.005).
 Conclusion: From our study we concluded that Dexmedetomidine is a better adjuvant than Fentanyl as it provides rapid onset and prolonged sensory and motor block, hemodynamic stability with excellent post operative analgesia.

The Effect of Preoperative Gabapentin on the Duration of Spinal Anaesthesia in Patients Undergoing Lower Limb Surgery: A Randomized Controlled Clinical Trial

Background: In the present study, we aim to examine oral gabapentin efficacy as an adjuvant to spinal anesthesia. Methods: This prospective, clinical, randomized trial included subjects between 20 and 60 years undergoing lower limb surgeries categorized into two cohorts. Group (G) received gabapentin (900 mg) in two divided doses prior to spinal anesthesia; (300 mg 10 hrs prior to spinal anesthesia induction as well as 600 mg 2 hrs before spinal anesthesia). In contrast, the control Group (C) received only spinal anesthesia. The onset, as well as the duration of spinal anesthesia, were the primary outcome, while the secondary outcome was the postoperative nalbuphine consumed. Results: A total of 60 cases were evenly categorized into two cohorts. Both groups demonstrated no differences regarding motor and sensory block onset and duration. The group receiving preoperative gabapentin had a significant decrease in postoperative nalbuphine consumption with a mean of 20.8±9.4 mg compared to the control group, which showed an increased consumption of 28.9±10.4 mg with a p-value of 0.006. Further analysis of the Visual Analog Score (VAS) in both groups revealed that the decrease in total nalbuphine consumption was found at (8 and 10 hrs) postoperatively, with p values of 0.016 and 0009, respectively. Conclusion: Gabapentin administration (900 mg) within 10 hrs of surgery in two subdivided doses prior to spinal anesthesia had no effect on onset and duration of spinal anesthesia but had a delayed beneficial postoperative analgesic effect. Clinical Trial Registration Number: This trial was registered at ClinicalTrials.gov (NCT05659810, URL: https://clinicaltrials.gov/ct2/show/NCT05659810in 21st December 2022.

Analgesic Efficacy of Dexmedetomidine as an Adjuvant to Ropivacaine in Supraclavicular Brachial Plexus Block for Upper Limb Surgeries: A Prospective Randomized Study

Background and Aims: The primary aim of this randomized controlled study was to evaluate the effect of the addition of dexmedetomidine to ropivacaine on the onset and duration of sensory and motor blockade and the duration of analgesia in patients undergoing upper limb surgeries under supraclavicular brachial plexus block. Materials and Methods: A total of 100 patients of age 18–55 years, planned for elective upper limb surgeries under supraclavicular brachial plexus block using a nerve stimulator, were randomly allocated into two groups. Group 1 (n = 50) received 30 mL 0.5% ropivacaine and 1 mL normal saline and Group 2 (n = 50) received 30 mL 0.5% ropivacaine and 1 μg/kg of dexmedetomidine. The onset and duration of sensory and motor block, duration of analgesia, and adverse events during the perioperative period were noted. Results: The onset of sensory and motor block in Group 1 (16. 26 ± 2.23 and 21.68 ± 2.90 min) was slower than those in Group 2 (9.12 ± 2.40 and 12.68 ± 2.62 min), (<0.001). The duration of sensory and motor block in Group 1 was significantly shorter than those in Group 2 (P < 0.001). The duration of analgesia in Group 1 (402.80 ± 28.21 min) was shorter than that in Group 2 (981.00 ± 92.26 min; P < 0.001). There was no statistically significant difference between the two groups in the incidence of the side effects, except in the incidence of sedation which is significantly higher in Group 2, (P < 0.001). Conclusion: Dexmedetomidine with ropivacaine for supraclavicular nerve block resulted in earlier onset and prolonged duration of the sensorimotor blockade and provided a longer pain-free postoperative period without significant hemodynamic alterations.

Comparative study between dexmedetomidine and dexamethasone as an adjuvant to levobupivacaine for supraclavicular brachial plexus block in patients undergoing upper limb surgeries

Background: Brachial plexus block (BPB) is widely used nowadays in patients undergoing upper limb surgery. Levobupivacaine is one of the best local anesthetics in the current scenario in this field. Both dexmedetomidine (DM) and dexamethasone (DX) are commonly used local anesthetic adjuvants in BPB to enhance blocking effects. In anesthesiology, there is always a search for a better alternative. Aims and Objectives: In this study, we investigated the effect of DM and DX as adjuvants to levobupivacaine on the quality of supraclavicular BPB. Materials and Methods: A prospective, double-blind, randomized controlled intervention study (superiority trial) was done involving 60 patients aged 20–60 years, randomly allocated into two equal groups (group S-DM group-Patients were received Injection 0.25% Levobupivacaine 2 mg/kg body weight+Inj. DM 1 mcg/kg body weight+distilled water [total volume 30 mL] and group C-DX group-Patients received Inj. 0.25% Levobupivacaine 2 mg/kg+Inj. DX 0.1 mg/kg body weight+Distilled water [total volume 30 mL]). The scores of the modified Gormley and Hill scale and the modified Bromage scale were recorded along with hemodynamic parameters. Pearson’s Chi-square test, Mann-Whitney U-test, one-way ANOVA, Kaplan–Meier survival analysis, and Z-test were used for statistical analysis. Results: The onset of motor block was shorter in group-S patients (14.2667±1.0807 [min]) compared to group-C (15.9333±1.5742 [min]), and the duration of motor block was higher in group-S (708.5667±4.2644 [min]) compared to group-C patients (682.3667±20.0095 [min]) (P<0.001). Conclusion: DM is a better alternative to DX when added to levobupivacaine for decreasing the onset of sensory and motor block and increasing the duration of supraclavicular BPB.

Intrathecal midazolam is a comparable alternative to fentanyl and nalbuphine as adjuvant to bupivacaine in spinal anesthesia for elective Cesarean Section; a randomized controlled double-blind trial

Background: Different adjuvants have been introduced to enhance the quality of local anesthetics and reduce its adverse events. This study was directed to compare the anesthetic and analgesic properties of intrathecal hyperbaric bupivacaine when three different adjuvant drugs were added.
 Methodology: One hundred full-term parturients aged 18 to 40 years, scheduled for elective cesarean section, were randomly assigned to 4 groups. Each group received 12.5 mg of 0.5% hyperbaric bupivacaine combined with either 0.5 ml saline (Group-B), 25µg fentanyl (Group-F), 0.8 mg nalbuphine (Group-N) or 2 mg midazolam (Group-M). The outcomes included the postoperative effective analgesia time, the sensorimotor characteristics, postoperative VAS score, pethidine consumption, maternal complications, and neonatal Apgar score.
 Results: Earlier onset of sensory and motor block was observed in Group F and N than in Group B and M. Duration of postoperative effective analgesia was longer in Groups F, N and M (252.42 ± 46.11, 227.34 ± 36.54 and 243.71 ± 44.95 hours, respectively) than in Group B (172.11 ± 20.99) (P < 0.001). VAS scores decreased in adjuvant groups during the first 12 hours postoperative and required pethidine doses were less.
 Conclusion: Addition of adjuvant agents to intrathecal bupivacaine improved the quality of subarachnoid block without increasing side-effects. Intrathecal midazolam provided comparable outcomes as the frequently used opioids.
 Abbreviations: CS: Cesarean section; LA: Local anesthetics; SA: Spinal anesthesia
 Key words: Intrathecal; Nalbuphine; Midazolam; Fentanyl; Postoperative analgesia; Cesarean section.
 Citation: Amin SR, Souidan I, Abdelzaam EM. Intrathecal midazolam is a comparable alternative to fentanyl and nalbuphine as adjuvant to bupivacaine in spinal anesthesia for elective cesarean section: a randomized controlled double-blind trial. Anaesth. pain intensive care 2022;27(1):89−96; DOI: 10.35975/apic.v27i1.1923
 Received: June 26, 2022; Reviewed: November 28, 2022; Accepted: December 14, 2022

Comparison of USG-Guided Supraclavicular Brachial Plexus Block by Single-Point Versus Multiple-Point Injection Technique: A Prospective Randomized Trial.

Background This study investigated the success rate of ultrasonography (USG)-guided supraclavicular block using a single-point injection technique comparing it with multiple-point injection technique, in terms of nerve sparing, time taken to perform the procedure, time taken to onset of sensory and motor block. Materials and methods A total of 204 patients of American Society of Anesthesiologists (ASA) Status I and II, aged 18-60 years, with body mass index (BMI) ≤30 kg/m2, posted for upper limb surgeries were given USG-guided supraclavicular brachial plexus block with 15 mL of 0.5% Ropivacaine. The patients were randomly divided into group A (single-point injection) and group B (multiple-point injection), using an out-of-plane technique. Sensory and motor block was assessed for onset and maximum grade achieved, by using pinprick, cold, touch, and movement respectively. The efficacy of the block was tested by assessment in the territories of musculocutaneous, ulnar, radial, median, axillary, and intercostobrachial nerves. Procedural time was calculated from the insertion of the needle till the complete injection of the drug. Results Patients in both groups were comparable in terms of demography and ASA status. The success rate for group A was 60.8%, compared to 98% in group B. In group B, the intercostobrachial nerve was most commonly spared (7.84%), followed by ulnar (1.96%), and radial (0.98%). On the other hand, in group A, the most frequently spared nerves were ulnar and intercostobrachial (23.5% each), followed by radial (12.7%), axillary (10.8%), musculocutaneous (7.8%), and median nerves (6.9%). The onset of sensory and motor block was similar in both groups. The procedure time was longer in the multiple-point group. Conclusion Our observations suggest that nerve sparing is much lesser in the multiple-point injection technique used for USG-guided supraclavicular block. In a good number of patients using this technique, the intercostobrachial nerve gets blocked.

Evaluation of adding magnesium sulphate to intrathecal bupivacaine in lower limb orthopedic surgery

BackgroundA subarachnoid block is the cheaper and widely used regional block for lower limb surgery. Postoperative pain occurs after lower limb orthopedic surgery from moderate to severe. We conducted a prospective, randomized, double-blind controlled trial. All patients were assessed for onset and duration of sensory and motor block, total duration of analgesia, and postoperative pain relief.This study was conducted to evaluate the efficacy of intrathecal bupivacaine with magnesium undergoing lower limb orthopedic surgery.ResultsOne hundred patients were randomly divided into two equal groups. Group M: Intrathecal 3 ml (15 mg) of 0.5% bupivacaine + 0.2 ml (50 mg) of preservative-free 25% of magnesium sulphate. Group B: Intrathecal 3 ml (15 mg) of 0.5% bupivacaine + 0.2 ml preservative-free 0.9% normal saline. The mean time that occurred for the sensory blockade at T10 was 2.49 ± 0.49 min in group B, while it was 4.13 ± 0.74 min in group BM (p value < 0.0001). The mean of the total duration of the sensory block in group B was 139.5 ± 32.01 min, while it was 366.4 ± 30.12 min in group BM (p value < 0.0001). The time taken for the onset of motor block in group B was 5.28 ± 1.31 min, while it was 7.86 ± 1.19 min in group BM (p value < 0.0001). The mean total duration of the motor block in group B was 136.3 ± 8.19 min, while it was 336.5 ± 37.08 min in group BM (p value < 0.0001). The total duration of analgesia in group B was 141.4 ± 14.85 min, while it was 365.9 ± 44.91 min in group BM (p value < 0.0001). The mean dose required for rescue analgesia in group B was 2.2 ± 1.14, while in group BM was 1.28 ± 0.96 (p value < 0.0001).ConclusionsThe addition of 50 mg magnesium sulphate in intrathecal hyperbaric bupivacaine significantly prolongs the extended duration of sensory, motor blockade, and total duration of analgesia for patients undergoing lower limb orthopedic surgery.

A Randomized Control Trial to Compare the Onset and Duration of Sensory and Motor Blockade with Intrathecal Isobaric Ropivacaine versus Isobaric Ropivacaine-Clonidine for Infraumbilical Surgeries

Background: To investigate the onset and duration of sensory and motor blockade in isobaric 0.75% Ropivacaine and isobaric 0.75% Ropivacaine - Clonidine in patients undergoing infra umbilical surgeries.&#x0D; One year double-blinded randomized controlled trial.&#x0D; Methods: A total of 70 patients undergoing infra umbilical surgeries were allocated into two groups namely, Group I (n=35; Patients received 3 ml of isobaric 0.75 % ropivacaine intrathecally) or Group II (n=35; Patients received 3 ml of isobaric 0.75 % ropivacaine + 15 mcg of clonidine intrathecally). Onset and duration of Sensory and motor block and hemodynamic parameters were noted and compared.&#x0D; Results: The demographic parameters were comparable in both groups. The onset of sensory block was similar in both groups but the duration of sensory block was prolonged in group II (191.7±19.21 minutes) than in group I (180.8 ±13.08 minutes). The motor block onset was faster in group II (11.4±2.29 minutes) than in group I (13.6±2.29 minutes). Duration of motor block was prolonged in group II (271.3±18.32 minutes) than in group I (224.5±16.46 minutes).&#x0D; Conclusion: The addition of clonidine to 0.75 % isobaric ropivacaine intrathecally prolonged the duration of sensory and motor block but with no effect on the sensory onset but the faster onset of the motor block with no significant hemodynamic changes.

Analgesic and safety analysis of dexmedetomidine combined with ropivacaine in ultrasound-guided brachial plexus nerve block

Purpose: To investigate analgesic effect and safety of dexmedetomidine combined with ropivacaine in ultrasound-guided brachial plexus block in intercostal space.Methods: A total of 90 patients were scheduled to undergo upper limb surgery and divided into control and study groups, respectively. Patients in control group were given ropivacaine nerve block, while those in study group were given ropivacaine combined with dexmedetomidine mixture nerve block. The efficiency of sensory and motor block, secondary evaluation of block effect, visual analogue scale (VAS) scores at different postoperative moments, remedial analgesia and adverse reactions were compared between the two groups after 30 min of drug injection.Results: The success rate of sensory block was not significantly different between control group (91.11 %) and study group (93.33 %; χ2 = 0.155, p &gt; 0.05) but success rate of the motor block was significantly higher in study group (93.33 %) than in control group (71.11 %; χ2 = 7.601, p &lt; 0.05). Compared with control group, onset of sensory block and motor block were significantly shorter in study group, while the duration of sensory block and motor block was significantly longer (p &lt; 0.05). The VAS scores at 12, 24, and 48 h postoperatively were significantly lower in study group than control group (p &lt; 0.05). The number of self-administered analgesia, number of patients, dose used, and overall incidence of adverse reactions in study group were significantly lower than in control group (p &lt; 0.05).Conclusion: Dexmedetomidine and ropivacaine, when administered together, have a significant anesthetic effect during nerve block, which is safe and enhances their analgesic effect. However, the mechanism of improving analgesic effect of the combined plan, using a larger number of samples should be further investigated.

Effects of dexmedetomidine, fentanyl and magnesium sulfate added to ropivacaine on sensory and motor blocks in lower abdominal surgery: a randomized clinical trial.

This study aimed to compare the effects of intrathecal dexmedetomidine, fentanyl and magnesium sulfate added to ropivacaine on the onset and duration of sensory and motor blocks in lower abdominal surgery. This double-blind randomized clinical trial included 90 patients scheduled for lower abdominal surgery at Vali-Asr Hospital in Arak, Iran. The enrolled patients were randomly divided into three equal groups and then underwent spinal anesthesia. The first group received 10 μg of dexmedetomidine, the second group received 50 μg of fentanyl, and the third group received 200 mg of 20% magnesium sulfate intrathecally in addition to 15 mg of 0.5% ropivacaine. In the dexmedetomidine group, the mean arterial blood pressure was lower than the other two groups (P = 0.001). Moreover, the time to onset of sensory block (P = 0.001) and the mean duration of sensory block (P = 0.001) were shorter and longer, respectively, in the dexmedetomidine group than in the other two groups. In the dexmedetomidine group, the mean time to onset of motor block (P = 0.001) and the mean duration of motor block (P = 0.001) were lower and higher than in the other two groups, respectively. There was no significant difference in visual analog scale score, heart rate, administered opioid, and drug side effects among the three groups. Dexmedetomidine caused early sensory and motor blocks while prolonging the duration of sensory and motor blocks compared with the other two groups. In addition, dexmedetomidine reduced mean arterial blood pressure in patients. Based on the findings of this study, it is recommended that dexmedetomidine can be used in order to enhance the quality of sensory and motor block in patients.

Study of Dexmedetomidine as an Adjuvant to Bupivacaine- Lignocaine with Adrenaline in Supraclavicular Brachial Plexusblock

Supraclavicular brachial plexus block is a very popular mode of anesthesia for various upper limb surgeries, as it is easiest and most effective and has good post-operative analgesia. It is carried out at the level of trunks i.e7 at the middle of brachial plexus, resulting in homogenou spread of anesthetic agent throughout the plexus with a fast onset and complete block action.9 Dexmedetomidine, is potent, highly selective α2-adrenoceptor agonist, has been used as an adjuvant during regional and local anesthesia because of rapid onset of action and relatively short half-life up to 2 hours. Objective of Study: To compare the effects of addition of Dexmedetomidine to Bupivacaine- Lignocaine with Adrenaline combination for Supraclavicular brachial plexus block with regards to onset and duration of sensory block, motor block. Quality of anesthesia, analgesia and Adverse reactions if any after taking written informed consent. Observations: Onset of sensory as well as motor blockade in Dexmedetomidine group was earlier when compared to plain bupivacaine-lignocaine adrenalin group. The duration of sensory and motor blockade was significantly increased (p&lt;0.05) in Dexmedetomidine group when compared to another group. With respect to hemodynamic parameters Dexmedetomidine group provided a higher Degree of cardiovascular stability with a lesser incidence of hypotension. Result: There is earlier onset of action and longer duration of sensory; Motor block and Duration of analgesia (sensory block) was prolonged in dexmedetomidine group. Hence it is advisable to add dexmedetomidine as an adjuvant to local anesthetic combinations during supraclavicular block for prolonged anesthesia and to provide better analgesia

A CLINICAL COMPARATIVE STUDY OF ULTRASOUND-GUIDED POPLITEAL NERVE BLOCK WITH 0.5% BUPIVACAINE HYDROCHLORIDE WITH AND WITHOUT 8MG DEXAMETHASONE FOR KNEE SURGERIES

Objective: This study aimed to see how adding dexamethasone 8 mg to 0.5% bupivacaine affected the length of sensory and motor blockage of the popliteal sciatic nerve in ankle and foot surgeries.&#x0D; Methods: This prospective randomized clinical comparison trial enrolled 60 patients with American Society of Anesthesiologists (ASA) physical status grades III and IV, aged 50-80 y, scheduled for ankle and foot procedures from March 2023 to July 2023. Patients were assigned into two groups of 30 at random. 28 ml of 0.5% bupivacaine and 8 mg dexamethasone were given to Group D. Group N was given 28 ml of o.5% bupivacaine and 2 ml of NS. Here, 20 ml was used for sciatic nerve block and 10 ml for saphenous nerve block.&#x0D; Results: The mean onset of sensory block in group D was 23.2±6.8 min, while 21.7±6.9 min in group N (p 0.3999). This was not statistically significant. The onset of motor block was 22.9±7.9 in group D and 22.3±7.1 in group N, which were statistically insignificant (p 0.7581). The duration of the motor block in group D was 11.3±3.2 h, whereas it was 5.9±2.3 h in group N (p 0.0001), which was statistically significant. The length of the sensory block in group D was 14.9±3.8 h, while it was 8.3±3.4 h in group N (p 0.0001), which was also statistically significant. The VAS score in group N was significantly higher than in group D; it began 3 h after surgery and remained at 4 h, 5 h, 6 h, 8 h, 10 h, and 12 h. All 30 patients in Group N required their first rescue analgesia during the first 12 h postoperatively. In contrast, only 12 patients (40%) required their first analgesia within the first 12 h, and 18 (60%) requested their first analgesia within the second 12 h.&#x0D; Conclusion: Adding 8 mg dexamethasone to 0.5% Bupivacaine hydrochloride in ultrasound-guided popliteal and saphenous nerve blocks for ankle and foot procedures extends postoperative sensory and motor block duration.

Comparison of lidocaine and its combination with ketamine for distal intravenous regional anesthesia (DIVRA) in bovines

The hoof diseases of cattle can be managed surgically under intravenous regional anesthesia (IVRA). For routine induction of IVRA, a tourniquet is placed circumferentially at the metacarpus/metatarsus. In the present study, hoof diseases of cattle were corrected using a modified IVRA technique. The cattle with hoof ailments were randomly divided into two groups and a tourniquet was placed just distal to the dew claws instead of at the metacarpus/metatarsus in order to decrease the dose of anesthetic. In group I lidocaine (2mg/kg) and in group II a mixture of lidocaine and ketamine (2mg/kg+1.5mg/kg) was injected into the axial digital vein to induce distal intravenous regional anesthesia (DIVRA). The heart rate, respiration rate, systolic and diastolic pressure were unaffected in both groups. Oxygen saturation was significantly (P&lt;0.05) lower between 5 and 60 minutes in group I and between 15and 40 minutes in group II animals. The sensory and motor block onset time was shorter, and the sensory and motor block recovery time was longer in group II animals as compared to group I animals. It was concluded that the DIVRA technique using lidocaine alone and lidocaine admixed with ketamine are suitable for hoof examination and surgery.

A COMPARISON BETWEEN INTRATHECAL NALBUPHINE AND DEXMEDETOMIDINE AS ADJUVANTS TO HYPERBARIC BUPIVACAINE FOR LOWER LIMB ORTHOPEDIC SURGERIES

Objective: Sub arachnoid block is a reasonably safe and simple technique of regional anesthesia. This randomized double-blind study was conducted to compare the efficacy of intrathecal nalbuphine and Dexmedetomidine as adjuvant with hyperbaric bupivacaine for lower limb orthopedic surgeries. Methods: Sixty adult patients of American Society of Anaesthesiologists physical status 1 and 2 who were scheduled for elective lower limb orthopedic surgeries were divided into two groups, D and N, of 30 each. Group D patients received dexmedetomidine 4 mcg and Group N received nalbuphine 2 mg as adjuvant along with bupivacaine heavy 0.5% (3 mL) intrathecally. Sensory and motor block characteristics and time to first rescue analgesic (intravenous tramadol 100 mg) were the primary end points and drug-related side effects such as pruritis, nausea, vomiting, and respiratory depression were taken as secondary end points. Subsequently, data were entered into Microsoft Excel spreadsheet and Statistical Package for the Social Science software version 22 was used for statistical analysis. Results: All 60 patients showed adequate block. The onset of sensory and motor block was statistically comparable in both groups. The duration of sensory and motor block and duration of analgesia were markedly extended in dexmedetomidine group patients. There were no significant intraoperative or post-operative side-effects in both group of patients. Conclusion: Dexmedetomidine (4 mcg) increases the sensory and motor block duration and duration of post-operative analgesia significantly more than nalbuphine (2 mg), when administered intrathecally as an adjuvant to bupivacaine (15 mg).

The Analgesic Effects of Preemptive Ultrasound-Guided Pericapsular Nerve Group Block in Comparison with Erector Spinae Plane Block in Elderly Undergoing Hip Arthroplasty: A Randomized Controlled Trial.

Perioperative pain management strategies in the elderly undergoing hip arthroplasty need special and safe preemptive care. The primary aim of this study was to compare the analgesic effects of preemptive ultrasound-guided pericapsular nerve group (PENG) block and lumbar erector spinae plane block (L-ESPB) in the elderly undergoing hip arthroplasty. The time to the first postoperative rescue analgesia was measured. The secondary aim was to assess the ease of spinal positioning (EOSP), onset of sensory block, block performance time, and patient satisfaction. Before positioning for spinal anesthesia, 69 elderly patients undergoing hip arthroplasty were randomized into three groups (n = 23 per group). The first intervention group received ultrasound-guided PENG block with 20 mL bupivacaine 0.25%; the second intervention group received ultrasound-guided L-ESPB using the same dose of bupivacaine. In the control group, patients received spinal anesthesia without any block. The time to first postoperative rescue analgesic (morphine) was significantly prolonged in the PENG group (13.3 ± 3.5 h) compared to the L-ESPB (9.5 ± 2.3 h) and control (2.6 ± 0.4 h) groups. The EOSP score was significantly higher in the PENG group compared to the L-ESPB and control groups (P < 0.001). The block performance time and oneset of the sensory block were significantly shorter in the PENG group compared to the L-ESPB group. The highest patient satisfaction scores were observed in the PENG group. Preemptive pericapsular nerve group block postponed the need for postoperative analgesia and eased spinal positioning compared to L-ESPB in the elderly undergoing hip arthroplasty.

Comparison of Two Different Doses of Buprenorphine as Adjuvants to Intrathecal Levobupivacaine in Lower Abdominal Surgeries

Background: Levobupivacaine because of its longer duration of action and better safety profile has gained popularity in regional anaesthesia. Intrathecal opioids synergise with Local anaesthetics and potentiate subarachnoid block. We conducted this study with the primary aim to compare analgesic efficacy of two different doses of buprenorphine as adjuvant to isobaric Levobupivacaine and the secondary aim to compare the onset and duration of sensory and motor blockade, hemodynamic variability and adverse effects if any.&#x0D; Methods: One hundred and twenty patients of American society of anaesthesiologist (ASA) I and II were divided in 3 groups of 40 each. Group A :0.5%levobupivacaine, group B: 0.5%levobupivacaine with 60 mcg buprenorphine Group C:0.5 %levobupivacaine with 90mcg buprenorphine. Duration of analgesia, onset of sensory and motor block, VAS scores, haemodyanamic parameters and adverse effects were noted.&#x0D; Results: The duration of analgesia was significantly prolonged in group C (11±0.41) h than group B (8.5±0.61) hour and Group A (4.8 ±40) hour (p &lt; 0.001). Onset and duration of Sensory and motor blockade was not significantly different. VAS score was significantly lower in group C (p&lt;0.001), hemodynamic parameters were well preserved with higher incidence of PONV in group C (10%).&#x0D; Conclusion: Addition of buprenorphine to intrathecal Isobaric Levobupivacaine prolonged the duration and quality of postoperative analgesia after lower abdominal surgery. Increasing the dose of buprenorphine from 60mcg to 90mcg provided longer duration of analgesia with minimal adverse effects like dizziness and PONV which were not significant to hinder recovery.

To compare the efficacy of intrathecal 0.75% heavy ropivacaine and 0.5% heavy bupivacaine for lower abdominal and lower limb surgery

Background: Spinal anesthesia is the most popular regional anesthesia technique for lower limb and lower abdominal surgery. Bupivacaine 0.5% heavy is commonly used for intrathecal use. New long-acting local anesthetic agents such as ropivacaine have claimed benefits of reduced cardiac toxicity on overdose and more specific effects on sensory rather than motor nerve fibers. The use of intrathecal hyperbaric ropivacaine is not much studied. With this background, we studied intrathecal ropivacaine hyperbaric 0.75% against intrathecal bupivacaine hyperbaric 0.5% for lower abdominal and lower limb surgery. Aims and Objectives: To note the effectiveness of intrathecal ropivacaine and bupivacaine on characteristics of subarachnoid block such as sensory block, motor block, hemodynamic parameters, and complications if any. Materials and Methods: We randomized patients undergoing lower abdominal surgeries and lower limb orthopedic surgeries under spinal anesthesia into two groups so as to receive intrathecal either ropivacaine 0.75% hyperbaric (3 mL) or bupivacaine 0.5% hyperbaric (3mL) and noted study parameters. Results: Time of sensory block onset (P=0.0005), peak sensory level (P=0.0029), and onset of L1 bromage-3 motor block (P=1.27E–08) was significantly delayed in the ropivacaine group as compared to bupivacaine group. However, maximum sensory level achieved (T6), time required for two-segment sensory regressions (P=0.1162), and time of onset of pain (P=0.1162) were comparable in both groups. Conclusion: Intrathecal ropivacaine 0.75% hyperbaric produced slow onset sensory and motor block than 0.5% hyperbaric bupivacaine with comparable cephalic spread and duration of sensory block.

Fractionated dose versus bolus dose of isobaric injection ropivacaine (0.75%) for patients undergoing elective caesarean section under spinal anaesthesia: A randomized, double-blind study

Background: Spinal anaesthesia (SA) using a bolus dose of Ropivacaine (0.75%) is known for its rapid onset but potential chances of hypotension. Administering Ropivacaine (0.75%) in fractions with intervals between the doses, has shown to establish a dense block, prolong analgesia and maintain better hemodynamic stability. This study aimed to compare the efficacy of fractionated and bolus doses of Ropivacaine (0.75%) in patients undergoing elective lower segment caesarean section (LSCS) under spinal anaesthesia. Methods: In a randomized, double-blinded trial, sixty patients scheduled for elective LSCS were enrolled and assigned to two groups. Group A received a single bolus spinal anaesthesia using Ropivacaine (0.75%) (2.5ml), while Group B received a fractionated dose approach: two-thirds of the total Ropivacaine (0.75%) dose (1.6ml) initially, followed by one-third dose (0.9ml) after 90 seconds. Results: The onset of sensory block (Group A: 3.59±1.31 min, Group B: 4.25±0.63 min) and motor block (Group A: 5.49±2.30 min, Group B: 7.34±11.28 min), as well as the duration of analgesia, were significantly longer in Group B (233.33±16.47 min) compared to Group A (185.17±20.61 min) (P &lt; 0.05). Hemodynamic stability was superior in Group B, with all patients showing better stability than those in Group A. Conclusion: Utilizing a fractionated dose of Ropivacaine (0.75%) in spinal anaesthesia results in an extended duration of analgesia and improved hemodynamic stability compared to a bolus dose approach.

MGSO4 AND DEXMEDETOMIDINE AS ADJUVANTS TO LOCAL ANAESTHETICS IN BRACHIAL PLEXUS BLOCK (USG GUIDED) FOR UPPER LIMB SURGERY: A COMPARATIVE EVALUATION

Background: Peripheral nerve block has become quite popular in outpatient and inpatient anaesthesia for upper limb procedures due to its safety and unmatched success rate. Supplementing local anaesthetics with adjuvants extends the postoperative time as well as providing intraoperative care. The objective is to assess the effectiveness of bupivacaine and MgSO4 as adjuvants in the supraclavicular brachial plexus block. Methods and Results: 60 Patients were arbitrarily split into two equal groups. 20 mL of 0.5% Bupivacaine with 1 mL of Dexmedetomidine (100 g) were injected into Group D (n = 30), ) and 20 mL of 0.5% Bupivacaine with 1 mL of MgSO4 (250 mg) were injected into Group M (n = 30). Hemodynamic parameters, sedation score, analgesia onset and duration, and satisfaction scores were all chronicled. The onset of sensory block was faster in Group D (5.43 ± 0.48 min) than in Group M (7.09 ± 0.14 min). The time of onset of motor block was faster in Group D (8.14 ± 0.56 min) than in Group M (10.87 ± 0.71 min) The duration of analgesia was again higher in Group D (1012.2 ± 24.15min) than in Group M (607.4±11.72 min). Conclusions:When compared to patients receiving MgSO4, patients receiving dexmedetomidine have sensory and motor blocks that begin earlier, endure longer, and have smaller postoperative rescue analgesia requirements. With dexmedetomidine, there is a greater frequency but non-significant incidences of hypotension, bradycardia, and better sedation score.