Onset Of Sensory Block Research Articles

Antishivering effect of intrathecal versus intravenous tramadol in patients undergoing urethroscopic lithotripsy under spinal anesthesia

Background: Shivering is the most common complication seen in the perioperative period in patients undergoing urological surgeries under spinal anesthesia. Intravenous tramadol is used for the treatment of shivering. Aims and Objectives: In this study, we wanted to assess the prophylactic effect of tramadol, intrathecal (IT) versus intravenous with the control group, in decreasing the incidence of shivering. Materials and Methods: Fifty-four eligible patients posted for urethroscopic lithotripsy (URSL) were randomly allocated into three equal groups – Group C: Received 2.5 mL 0.5% bupivacaine heavy + 0.5 mL normal saline intrathecally and 5 mL of normal saline intravenously, Group V: Received 2.5 mL of 0.5% bupivacaine heavy+0.5 mL normal saline intrathecally and 25 mg tramadol in 5 mL of normal saline intravenously, and Group T: Received 2.5 mL of 0.5% bupivacaine heavy + 25 mg (0.5 mL) of tramadol intrathecally and 5 mL of normal saline intravenously. The incidence and severity of shivering were noted. Onset of sensory and motor block, duration of post-operative analgesia, core body temperature, and adverse effects such as nausea, vomiting, and hypotension were noted. Results: The incidence of intraoperative shivering was significantly lower in Group T versus C (P=0.014) but comparable among Group I versus C (P=0.502) and Group T versus I (P=0.06). The duration of analgesia was significantly higher in Group T compared to Groups I and C (P<0.001). The additional tramadol requirement was significantly lower in Group T versus I and in Group T versus C but comparable among Group I versus C. Conclusion: The addition of 25 mg tramadol to IT 0.5% bupivacaine heavy is effective in preventing intraoperative shivering in patients undergoing urological surgeries like URSL.

Effects of Ketamine and Tramadol As Adjuvants to Bupivacaine in Spinal Anesthesia for Unilateral Open Ovarian Cystectomy: A Randomized Controlled Trial.

Spinal anesthesia offers numerous advantages and desirable features. However, it is associated with various side effects related to local anesthetic agents used. Reducing the dose of local anesthetic in spinal anesthesia can help minimize side effects but may lead to a diminished analgesic effect or failure of anesthesia. Therefore, adding an adjuvant may enhance the benefits while mitigating side effects. This study aimed to evaluate the effects of ketamine and tramadol as adjuvants to bupivacaine on the duration of spinal analgesia. The objectives were to compare the three groups and prove their analgesic effects, safety, and superiority.The primary outcomes werethe duration of spinal analgesia, as well as the onset and duration of both sensory and motor blocks. Secondary outcomes included the heart rate, mean arterial pressure, and the incidence of undesired effects such as nausea, vomiting, sedation, shivering, and postoperative headache. In this double-blind randomized controlled trial, 120 female patients undergoing elective open unilateral ovarian cystectomy under spinal anesthesia were studied. The inclusion criteria included patients aged 16-45 years with a physical status classified as American Societyof Anesthesiologists (ASA) class I and II. Patients were randomly allocated into three groups: group B (n=40) received only bupivacaine, group BK (n=40) received bupivacaine mixed with preservative-free ketamine, and group BT (n=40) received bupivacaine mixed with preservative-free tramadol. The mean duration of spinal analgesia, measured in minutes, showed significant differences (P < 0.001) between group BK (165 ± 4) and group B (170 ± 5). There was also a significant difference between group BT (313 ± 8) and group B (170 ± 5) (P < 0.001). Additionally, significant differences were observed between group BK (165 ± 4) and group BT (313 ± 8) (P < 0.001). The administration of 25 mg of ketamine and 25 mg of tramadol as adjuvants to bupivacaine in spinal anesthesia significantly affected the postoperative duration of analgesia. Tramadol prolonged the duration of spinal anesthesia, while ketamine shortened it. The use of both adjuvants did not result in undesired effects.

Efficacy and safety of extrafascial injection versus intrafascial injection for interscalene brachial plexus block: a systematic review and meta-analysis.

This systematic review and meta-analysis aimed to assess the efficacy and safety of interscalene brachial plexus block (ISB) techniques in upper limb and shoulder surgeries. We conducted a comprehensive search of PubMed, Web of Science, Cochrane Central Register of Controlled Trials, Embase, Medline, and Scopus databases up to May 14th, 2023. We employed a search strategy involving keywords such as "brachial plexus block," "interscalene brachial plexus block," "ISB," "extrafascial," and "intrafascial," without applying search restrictions or filters. Eligible studies consisted of randomised controlled trials (RCTs) that compared extrafascial and intrafascial ISB techniques in adult patients undergoing upper limb and shoulder surgeries. Our analysis included six RCTs encompassing 485 participants. Extrafascial injection demonstrated superiority over intrafascial injection in reducing the incidence of hemidiaphragmatic paresis (RR 0.33, 95% CI 0.124 to 0.47, P<0.00001) and preserving respiratory function (MS 0.31, 95% CI 0.1 to 0. 52, P=0.003 FEV<inf>1</inf> in liters). Additionally, extrafascial ISB exhibited a lower risk of block-related complications (RR 0.35, 95% CI 0.25 to 0.50, P<0.00001). However, the intrafascial technique offered a faster sensory and motor block onset. The duration of sensory block did not significantly differ. The incidence of Horner syndrome showed no statistically significant difference. Our findings favor extrafascial ISB techniques because they reduce hemidiaphragmatic paresis, preserve respiratory function, and lower block-related complications. However, further research is necessary to establish their safety and efficacy in specific patient populations.

Intrathecal levo-bupivacaine versus hyperbaric bupivacaine for inguinal hernia repairs in ex-preterm infants: A double blinded randomized prospective study

ABSTRACT Background and aim The anesthetic management of premature neonates has many challenges resulting from immature physiological adaptations, the transitional circulation, increased presence of comorbidities and, prominently, the occurrence of apnea in preterm infants. The aim of the present study was to compare the efficacy and safety of levobupivacaine with hyperbaric bupivacaine for spinal anesthesia in preterm infants scheduled for inguinal hernia repair. Methods A double-blinded randomized, prospective, controlled study was conducted in a tertiary care pediatric surgery center from January 2017 to February 2021 where 60 preterm infants aged <45 weeks post-menstrual age (PMA) were scheduled for an elective inguinal hernia repair procedure. Preterm infants comforted by a sugared pacifier were divided randomly into two groups (30 infants each). Group I received spinal anesthesia with 1 mg/kg 0.5% hyperbaric bupivacaine, while group II received spinal anesthesia with1mg/kg o.5% levo-bupivacaine. The primary objective was to assess the hemodynamic stability, sensory and motor blockade of intrathecal levo-bupivacaine compared to hyperbaric bupivacaine in premature infants, and secondarily was to monitor the incidence of postoperative apnea, length of stay (LOS), and need for postoperative ventilator support. Results The onset of sensory block of spinal anesthesia in group II was statistically significantly faster than in group I (Group I = 2.6 ± 0.52 min, Group II = 2.3 ± 0.35 min, p = 0.0112), with a statistically significant rapid regression in group II compared to group I (group I = 86 ± 2.45 min, Group II = 84 ± 3.67 min, p = 0.016). Conclusions Levo-bupivacaine is an effective and safe agent for spinal anesthesia and has an equivalent potency to hyperbaric bupivacaine for motor blockade in premature infants requiring inguinal hernia repair surgery.

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.

Comparison of the effect of dexmedetomidine intrathecal injection and intravenous infusion on subarachnoid blockade during knee arthroscopy procedures: a randomized controlled trial

BackgroundComparison of whether intrathecal dexmedetomidine prolongs spinal anesthesia-associated sensorimotor blockade more than intravenous infusion during knee arthroscopy procedures performed under subarachnoid blockade.MethodsNinety patients aged 18–75 years, ASA class I-II, who underwent knee arthroscopy between October 2022 and April 2023 were randomized into intrathecal、intravenous and control groups.Subjects received three modes of administration: an intrathecal group (2 ml of 1% ropivacaine + 1 ml of 5 μg dexmedetomidine, along with intravenous saline infusion), an intravenous group (intrathecal 2 ml of 1% ropivacaine + 1 ml of 0.9% saline, with dexmedetomidine pumped intravenously at a dose of 0.5 μg/kg/h), and a control group (intrathecal 2 ml of 1% ropivacaine + 1 ml of 0.9% saline, along with intravenous saline infusion). Total analgesic duration, duration of sensory and motor blockade, Ramsay sedation score, Visual Analogue Score (VAS) at different postoperative time points, and occurrence of adverse effects were recorded.ResultsThe total analgesia duration was significantly longer in the intrathecal group than in the intravenous and control groups (352.13 ± 51.70 min VS 273.47 ± 62.57 min VS 241.41 ± 59.22 min, P < 0.001).The onset of sensory block was shorter in the intrathecal group than in the intravenous and control groups (4 [3–4]min VS 5 [4–5]min VS 5 [4–5]min; P < 0.001);the onset of motor block was shorter in the intrathecal group than in the intravenous group and the control group (5 [4–5]min VS 5 [5–6]min VS 6[5.5–7]min; P < 0.001).Sedation scores were higher in the intravenous group than in the intrathecal and control groups (P < 0.001). At 5 h postoperatively, the VAS score in the intrathecal group was lower than that in the intravenous and control groups (P < 0.001). At 24 h postoperatively, the VAS score in the intrathecal group was lower than that in the control group (P < 0.001). In addition, the incidence of bradycardia was significantly higher in the intravenous group than in the intrathecal and control groups (30%, 6.5%, and 3.4%, respectively; P = 0.018, P = 0.007).ConclusionsIntrathecal administration of dexmedetomidine did prolong the total analgesia duration, as well as accelerate the onset of sensory-motor blockade compared with intravenous infusion, and did not result in any hemodynamic instability or other adverse events at the doses studied.Trial registrationThis single-center, prospective, RCT has completed the registration of the Chinese Clinical Trial Center at 26/09/2023 with the registration number ChiCTR2300076170.

A Prospective Randomized Controlled Double Blinded Interventional Study to Compare Post Operative Analgesia Using Sequential Intrathecal Injection of Fentanyl at Different Rates with Hyperbaric Bupivacaine in Lower Segment Caesarean Sections

Background: This study compared rapid and slow intrathecal fentanyl injection followed by a slow injection of bupivacaine to estimate the duration of postoperative analgesia in lower-segment caesarean sections (LSCS). Methods: The study was performed on 60 parturient aged 18-35 years undergoing LSCS and was divided equally into two groups. Group A (Normal Sequential) received slow sequential intrathecal injections of fentanyl and hyperbaric bupivacaine and Group B (Rapid Sequential) received a rapid intrathecal injection of fentanyl followed by a slow injection of hyperbaric bupivacaine. We compared the duration of postoperative analgesia, time of onset of sensory and motor block attained, the highest level of sensory block attained, duration of motor block, Visual Analogue Scale (VAS) scores, spinal anaesthesia-related complications and haemodynamic parameters between both the groups. Results: The duration of postoperative analgesia was longer (P &lt; 0.001) in group B (3.22 ± 0.66 hrs) as compared to group A (2.53 ± 0.41 hrs.) The onset of sensory block was faster (P &lt; 0.001) in group B (1.01 ± 0.29 min) as compared to group A (1.32 ± 0.08 min). More patients in group B achieved higher levels of sensory blockade as compared to group A (5 patients in group A and 12 patients ofgroup B achieved a sensory block up to the T2 dermatome). VAS scores and the requirement of rescue analgesia were significantly lower (10 in group B and 19 in group A). Conclusion: Rapid sequential intrathecal injection of fentanyl and hyperbaric bupivacaine provided better anaesthesia and postoperative analgesia than the normal group.

A Randomized Comparative Study to Evaluate the Efficacy of Dexmedetomidine used as an Adjuvant to Isobaric 1% 2-Chloroprocaine in Parturients Undergoing Elective Lower Segment Cesarean Section under Subarachnoid Block

Background and Aims: Preservative-free 1% 2-chloroprocaine (2-CP) is an amino-ester local anesthetic (LA), suitable for short duration daycare or ambulatory surgeries. Dexmedetomidine as an adjuvant may enhance the efficacy of LA. Our study aimed to evaluate the analgesic efficacy and safety of intrathecal dexmedetomidine as an adjuvant to 1% 2-CP in parturients undergoing elective lower segment cesarean section (LSCS). Material and Methods: After obtaining approval from the Institutional Ethics Committee and informed written consent, 100 term parturients aged 18–35 years, belonging to American Society of Anesthesiologists (ASA) physical status II, undergoing elective LSCS were randomly allocated into two groups. Group CD received 1% preservative-free 2-CP 3 ml (30 mg) +0.5 ml dexmedetomidine (5 µg) diluted in (normal saline) NS, while Group C (n = 50) received 1% preservative-free 2-CP 3 ml (30 mg) +0.5 ml NS. Among the various parameters noted, duration of sensory block was the primary outcome measure while the onset of sensory block, highest dermatomal level achieved, time to achieve highest dermatomal level, time to two-segment regression, onset and duration of motor block, duration of analgesia, Visual Analog Scale (VAS) score, Apgar score, hemodynamic changes, and side effects were secondary outcome measures. Results: Both groups were comparable with respect to demographic profile, onset of sensory block, onset and duration of motor block. The duration of sensory block (100.12 ± 15.41 versus 71.68 ± 4.68 min) (&lt;0.0001) as well as the duration of analgesia (113.08 ± 13.74 versus 81.60 ± 8.28 min) (&lt;0.0001) were significantly prolonged in Group CD compared to Group C. Apgar score of newborns, hemodynamic parameters, and adverse effects were comparable in two groups. Conclusion: Intrathecal dexmedetomidine (5 µg) as an adjuvant to preservative-free 1% 2-CP results in a prolonged duration of both sensory block and analgesia for LSCS without affecting motor block characteristics.

The Effect of Preoperative Anxiety on Motor and Sensory Block Duration and Effectiveness in Spinal Anesthesia

Introduction. The aim was to evaluate the effect of preoperative anxiety on the sympathetic block that developed after spinal anesthesia and therefore the duration of motor and sensory blockade. Materials and Methods. After the approval of the ethics committee, 90 patients between the ages of 18 and 55 years who were to be operated under spinal anesthesia were included in the study. Preoperative anxiety of the patients was evaluated with the Spielberger trait and State Anxiety Scale and Visual Analog Scale (VAS). The Bromage scores of the patients were followed up intermittently. Onset time of sensory block, onset time of motor block, and motor block recovery time were recorded. Cases with bradycardia and hypotension were noted. Results. No statistically significant correlation was found between the duration of motor block onset (5.81 ± 4 min), the sensory block onset time (0.89 ± 0.4 min), and the motor block recovery time (92.06 ± 36.9 min) with other variables. VAS (5.81 ± 2.5), STAI‐1 (40.4 ± 9.8), and STAI‐2 (41.69 ± 8.2) values had a statistically significant effect on the occurrence of bradycardia (14.4%). The variables of VAS, STAI‐1, STAI‐2, sensory block onset, motor block onset, and motor block recovery time were statistically significantly higher in women (mean 5.24 ± 2.4, 38.97 ± 9.9, 41.43 ± 8.7, 0.89 ± 0.42, 5.64 ± 3.82, and 88.77 ± 38.74 in males and mean 7.15 ± 2.1, 43.74 ± 8.9, 42.30 ± 7.0, 0.88 ± 0.27, 6.20 ± 4.35, and 99.70 ± 31.70 in females, respectively). Conclusion. It was observed that preoperative anxiety had no effect on motor and sensory block onset and duration.

Comparison of Analgesic Efficacy of Levobupivacaine with or without Dexamethasone in Lower Abdominal Surgeries under Subarachnoid Block: A Pilot Randomised Controlled Trial

Introduction: Subarachnoid Block (SAB) is a commonly used technique for lower abdominal surgery. Dexamethasone has been proven effective as an additive when used with bupivacaine. However, there has been no study comparing the analgesic efficacy of dexamethasone with levobupivacaine under SAB. Aim: To compare the analgesic efficacy of levobupivacaine with or without dexamethasone in patients scheduled for lower abdominal surgeries. Materials and Methods: A pilot randomised doubleblind controlled trial was undertaken in the Department of Anaesthesiology, University College of Medical Sciences Guru Tagh Bahudur (UCMS-GTB) Hospital, New Delhi, India on 60 patients with Americian Soceity of Anaesthesiolgy (ASA) grade I or II, aged 18-65 years, undergoing lower abdominal surgeries under SAB from January 2021 to August 2022. In Group LS, 12.5 mg of 0.5% isobaric levobupivacaine (2.5 mL) with normal saline (1 mL) was administered, and in Group LD, 12.5 mg of 0.5% isobaric levobupivacaine (2.5 mL) with 4 mg dexamethasone (1 mL) was given. Patients were assessed for sensory and motor block, haemodynamic parameters, pain score, and side-effects. Unpaired t-tests/Mann-Whitney U tests were used to determine significance. A p-value of less than 0.05 was considered significant. Results: The two groups were comparable in terms of demographic profile. The age in the LS group was 37.80±9.98 years, and in the LD group, it was 38.63±12.37 years. The maleto-female ratio in the LS and LD groups was 17:13 and 21:9, respectively. The weight range in both groups was between 50 to 67 kg. The Basal Metabolic Index (BMI) was 22.40±2.43 kg/ m2 and 21.70±2.21 kg/m2 in the LD and LS groups, respectively. All these parameters, including height, had a p-value of more than 0.005, except for the duration of analgesia. The duration of effective analgesia was also longer in the LD group (247.00±36.69 min) than in the LS group (138.50±22.52 min) with a p-value of &lt;0.001. The time of onset of sensory block was 9.13±2.98 minutes in the LD group and 10.30±3.06 minutes in the LS group, which was statistically insignificant. Conclusion: Authors concluded addition of 4 mg (1 mL) of dexamethasone to 2.5 mL of 0.5% isobaric levobupivacaine provides a clinically longer duration of effective analgesia with early onset and better quality of sensory and motor block than 2.5 mL of 0.5% isobaric levobupivacaine alone. Therefore, 4 mg of dexamethasone with 2.5 mL of 0.5% isobaric levobupivacaine is recommended for lower abdominal surgeries under SAB.

Effects of Differences in Epidural Needle Entry Point and Angle of Rotation of Needle Hub on the Onset and Duration of Sensory Blockade in Lower Limb Orthopaedic Surgeries: A Randomised Controlled Trial

Introduction: Epidural anaesthesia is a boon for providing prolonged analgesia for postoperative pain relief. The influence of epidural needle insertion on the onset of the block, which has not been studied previously, is significant. Aim: To analyse the effect of epidural needle entry and rotation of the needle on the onset and duration of the block. Materials and Methods: This double-blinded randomised controlled trial was conducted at the Department of Anaesthesiology, SRM Institute of Science and Technology, Chennai, Tamil Nadu, India from March 2020 to August 2021 on 70 patients undergoing leg and ankle surgeries. They were randomised into Group-ML (midline approach) and Group-PM (paramedian approach). In Group-ML, midline epidural needle entry was followed by catheter insertion. In Group-PM, the needle entry was paramedian, and the bevel was turned 45º towards the surgical site for catheter insertion. A 10 mL of 0.5% bupivacaine was administered. Postoperatively, epidural infusion was initiated using 0.125% bupivacaine with 2 μg/mL fentanyl. The time taken for catheter placement, onset of motor and sensory blockade, maximum sensory level attained, duration of sensory blockade, consumption of local anaesthetics, haemodynamic profile, and the need for rescue analgesia were monitored. Continuous data were analysed using the Student's t-test, and categorical data were analysed using the Chi-squared test with International Business Machines (IBM) statistical product and service solutions software version 27.0 Results: Both groups were comparable with respect to demographics. The mean age in Group-ML was 40.9±25.93 years, while in Group-PM it was 41.028±20.576 years, with a p-value of 0.981. The mean BMI in Group-ML was 24.91±2.998 kg/m2 , while in Group-PM it was 24.96±2.527 kg/m2 , which was statistically insignificant with a p-value of 0.944. A total of 21 males in Group-ML and 28 males in Group-PM participated in the study; the distribution was found to be statistically insignificant with a p-value of 0.067. The time taken for the placement of the epidural catheter was around 288 seconds in Group-ML and 322 seconds in Group-PM, with a p-value of 0.0035. The onset of sensory block was around 17 minutes in Group-ML and 13 minutes in Group-PM, respectively, with a p-value of 0.0001. The duration of sensory block or the time taken for two-segment regression of level was around 102 minutes and 128 minutes in Group-ML and Group-PM, respectively (p-value 0.0001). The rescue analgesic was required in seven patients of Group-ML and none in Group-PM, with a p-value of 0.005. The haemodynamic profile intra and postoperatively and postoperative VAS score were statistically insignificant between the groups. Conclusion: The paramedian approach and epidural catheter insertion with the needle rotated at an angle of 45º towards the surgical side provide a rapid onset of the sensory and motor block with extended duration of the sensory blockade and reduced consumption of local anaesthetics.

Effectiveness of Consecutive Versus Premixed Administration of Fentanyl and Bupivacaine in Subarachnoid Block for Total Abdominal Hysterectomy

Background: Subarachnoid block (SAB) was a common regional anaesthetic technique, with opioids as adjuvants to enhance effectiveness and reduce hypotension. Objective: Comparison of the effectiveness of consecutive versus premixed administration of fentanyl and hyperbaric bupivacaine in subarachnoid block for TAH. Methods: This Quasi experimental study was carried out in 70 patients divided into two groups of 35 each: Group A received 0.5% hyperbaric bupivacaine 15mg (3ml) premixed with fentanyl 25µg (0.5ml) in a same syringe and Group Breceived fentanyl 25µg (0.5ml) in one syringe followed by 0.5% hyperbaric bupivacaine 15mg (3ml) in a separate syringe. The study compared the onset of sensory and motor block, reaching maximum sensory level, and complete motor block, as well as the time required for analgesia and ephedrine. Statistical significance was determined at a P-value &lt; 0.05. Results: The study found that group B had significantly less time for onset of sensory block(3.45±0.41 vs 2.65±0.32min), motor block (4.51±0.53 vs 3.31±0.46min), and total ephedrine consumption (15.29±6.52 vs 11.86±5.95mg)compared to group A. Additionally, the time of sensory (236.8±21.7 vs 269.6±24.3 min) and motor block regression (203.8±18.6 vs 237.5±20.8min), and first required analgesia (248.2±23.3 vs 283.8±23.4 min)was longer in group B. Conclusion: Consecutive administration of fentanyl and hyperbaric bupivacaine is more effective than premixed administration in subarachnoid block for total abdominal hysterectomy.

Efficacy of Magnesium Sulfate and Dexmedetomidine as Adjuvants to Ropivacaine in Supraclavicular Brachial Plexus Block: A Randomised Clinical Study

Introduction: Peripheral nerve blocks have recently proven to be extremely promising in terms of patient satisfaction. In upper limb procedures, rapid and deep anaesthesia can be achieved with supraclavicular ultrasound-guided access to the brachial plexus. To improve the quality of local anaesthesia, adjuvants such as magnesium sulfate and dexmedetomidine have been added to the local anaesthetic. Aim: To evaluate the efficacy of magnesium sulfate and dexmedetomidine as adjuvants to ropivacaine in supraclavicular Brachial Plexus Blockade (BPB). Materials and Methods: A prospective randomised doubleblind study was conducted in the Department of Anaesthesiology from June 2016 to November 2017 ( 1 year and 6 months) at King George's Medical University, Lucknow, Uttar Pradesh, India. A total of 60 patients were divided into two groups using a computer-generated random number for upper limb surgeries (below the mid-humerus) under supraclavicular brachial plexus block. Group A (n=30) received ropivacaine 0.5% (30 mL) plus dexmedetomidine 50 µg for the supraclavicular block, and Group B received ropivacaine 0.5% (30 mL) plus magnesium sulfate 150 mg in 1 mL Normal Saline (NS) 0.9% for the same block. A comparison of these two groups was conducted for the time of onset, duration of sensory and motor block, haemodynamic stability, postoperative analgesia, and complications. Statistical analyses such as Student’s t-test, Chi-square test, and MannWhitney U-test were used. Results: The mean age of Group A was 28.03±5.86 years and Group B was 31.07±7.06 years. The sensory block and motor block onset were significantly faster among patients of Group A (6.47±1.43 min and 8.50±1.46 min) compared to Group B (9.57±1.22 min and 11.77±1.19 min). The mean duration of analgesia was significantly longer (p&lt;0.001) in Group A (1034.10±61.07 min) compared to Group B (460.00±35.82 min). The duration of sensory block and motor block was also significantly higher (p&lt;0.001) in Group A compared to Group B. Both groups were haemodynamically stable, but sedation was significantly higher in Group A. Conclusion: Dexmedetomidine 50 µg is a superior adjuvant compared to magnesium sulfate 150 mg with ropivacaine 0.5% in supraclavicular brachial plexus block as it significantly hastens onset time and prolongs the duration of sensory and motor blocks and the duration of analgesia.

Comparison of Dexmedetomidine and Fentanyl Added to Levobupivacaine in USG-guided Axillary Block for Upper Limb Surgeries: A Randomised Double-blinded Controlled Study

Introduction: Apart from general anaesthesia, brachial plexus block by the axillary approach is one of the reliable sole anaesthetic techniques for patients undergoing upper limb surgeries. In this study, levobupivacaine was chosen due to fewer adverse effects compared to Bupivacaine, and fewer studies were available for the axillary approach to brachial plexus block. Adjuvants were added to hasten the onset and also to prolong their analgesic effect. Aim: To compare the effect of Dexmedetomidine (D) 0.5 mcg/kg and Fentanyl (F) 0.5 mcg/kg when added to 0.5% Levobupivacaine (L) as an adjuvant in brachial plexus block by the axillary approach for upper limb surgeries. Materials and Methods: A randomised double-blind controlled study was carried out at the Department of Anaesthesiology, Sree Balaji Medical College, BIHER, Chennai, Tamil Nadu, India from January 2020 to October 2021 on 60 American Society of Anaesthesiologists (ASA) I and II patients of either sex posted for various types of upper limb surgeries. Subjects were divided into two equal groups by computer-generated randomisation. Group A received 0.5% levobupivacaine and dexmedetomidine 0.5 mcg/kg, and Group B received 0.5% levobupivacaine and Fentanyl 0.5 mcg/kg. Both patients and the evaluator were unaware of the type of adjuvants added to the local anaesthetic. The onset time, duration of sensory and Motor blockade were recorded. Haemodynamic variables and duration of analgesia were recorded for 24 hours postoperatively. The Mann-Whitney U test demonstrated variations in the onset and duration of sensory and motor blocks. Adverse effects, including nausea, vomiting, and hypotension, exhibited significant differences according to Fisher’s-exact test. Results: Age and weight distributions were comparable between groups (mean age: Group A=45.20 years, Group B=44.80 years; mean weight: Group A=74.13 kg, Group B=74.43 kg). Group A exhibited faster sensory and motor block onset times (sensory: Group A=6.20 minutes, Group B=8.63 minutes; motor: Group A=8.27 minutes, Group B=10.00 minutes), longer block durations (sensory: Group A=11.63 hours, Group B=9.53 hours; motor: Group A=9.67 hours, Group B=8.20 hours), and required the first rescue analgesic (Group A=12.57 hours, Group B=10.27 hours) compared to Group B (p&lt;0.05). Similarly, the mean time for the first rescue analgesia for patients among these two groups was also statistically significant (p&lt;0.05). Conclusion: The addition of 0.5 mcg/kg dexmedetomidine to 0.5% levobupivacaine in axillary block was more effective in prolonging the duration of blockade and providing adequate intraoperative analgesia when compared to 0.5 mcg/kg fentanyl with 0.5% levobupivacaine, without producing any adverse events.

A comparative evaluation of 0.75% ropivacaine with fentanyl versus 0.75% ropivacaine with dexmedetomidine in intrathecal anesthesia for lower limb surgeries

Background: Anesthesia for lower limb surgeries can be administered locally, regionally (spinal or epidural), or generally. The primary option is still spinal anesthesia because of its quick onset, excellent blockage, low infection risk, low failure rate, and affordability. The most widely utilized method is bupivacaine spinal anesthesia. By extending and strengthening the sensory blockade, an adjuvant not only boosts the effectiveness of a local anesthetic but also lowers the dosage of local anesthetic drugs. Aims and Objectives: The aims and objectives of the study are to assess the synergistic effect and safety of adding dexmedetomidine to ropivacaine 0.75% in the subarachnoid block for lower limb surgeries compared to fentanyl to ropivacaine 0.75%. Materials and Methods: The present study was a prospective randomized control study, carried out at the Department of Anesthesiology and Critical Care, Kempegowda Institute of Medical Sciences, Bangalore, for a period of 2 years. Two groups of 30 subjects each were selected for the study by simple random sampling. Patients with physical status ASA 1 or 2 who underwent elective lower limb surgeries were included. Patients in Group F (n = 30) received 3 mL of isobaric 0.75% ropivacaine and 25 μg fentanyl (0.5 mL) and in Group D (n = 30) received 3 mL of isobaric 0.75% ropivacaine with 10 μg dexmedetomidine (0.5 mL). Sensory testing was assessed by loss of pinprick sensation. The motor block in the lower limb was graded according to the modified Bromage scale. Duration of analgesia was noted. Hemodynamic parameters were recorded every 5 min for 1st 30 min and thereafter every 30 min till the patient complained of pain. Results were analyzed using the SPSS 20.0 version and the association was tested using Student t-test and Chi-square test. Results: The average time for sensory block onset was 2.93 ± 0.25 min in Group D and 2.43 ± 1.14 min in Group F. In both Group D and Group F, the length of the sensory block was 281.33 ± 25.15 and 144.67 ± 19.43, respectively, and was extremely significant both statistically and clinically. When compared to Group F, which had analgesia for 144.67 ± 19.43 min, Group D experienced analgesia for a significantly longer duration, 360.67 ± 16.17 min. There was a statistically significant difference (&lt;0.001). In Group D, the average motor block duration was 339.67 ± 19.21 min, whereas in Group F, it was 92.33 ± 16.95 min. Conclusion: When compared to fentanyl as an adjuvant to ropivacaine, intrathecal dexmedetomidine causes a faster onset of sensory and motor blockade and a longer duration of motor and sensory block, as well as hemodynamic stability, higher sedation, and a longer duration of post-operative analgesia.

Do you mind the role of spinal sensory block duration in a crucial endocrine disorder of diabetes mellitus? A prospective observational study.

Diabetes mellitus, per se, is a global health concern, which is often accompanied by complications such as diabetic neuropathy. This prospective observational study purposed to assess the durations of spinal sensory block and motor blocks in individuals with and without diabetes mellitus who had undergone spinal anesthesia. This study incorporated 80 cases, which were evenly divided into spinal sensory block without diabetes mellitus and spinal sensory block with diabetes mellitus. Various parameters were recorded at different time points, including heart rate, mean arterial blood pressure, SpO2, and spinal block characteristics. Notable measures included maximum spinal sensory block onset time, time to reach the 10th thoracic vertebra (T10), maximal spinal sensory block, time for Bromage scores, and block regression while controlling for age-related variations. Patients in the diabetic group exhibited extended block durations, with significant differences in heart rate noted at specific time points. Regarding the spinal block characteristics, the "maximum onset of SSB" and the "time to reach the T10" were more prolonged in the SSBwDM without significance. Maximum sensory spinal sensory block did not differ. However, some cases in the SSBwDM displayed blocks extending up to the T6. The times to achieve Bromage motor block scores 1-3 were shorter in SSBwDM and lost significance regarding age. Notably, the regression time was longer in SSBwDM, which held significance for both parameters. Diabetic cases commonly encounter prolonged block durations post-subarachnoid intervention, potentially linked to nerve sensitivity, age-related changes, and glycemic control. As such, attenuated local doses for diabetic neuropathic cases may enhance early mobilization, attenuate thromboembolic events, and expedite gastrointestinal recovery.

Effect on Onset and Duration of Sensory and Motor Block with Single Bolus Dose of Intravenous Dexmedetomidine as an Adjuvant on Spinal Anesthesia with 0.5% Hyperbaric Bupivacaine in Lower Limb Surgery

Background: The hyperbaric bupivacaine is being widely used for spinal anesthesia in lower limb surgeries. Dexmedetomidine can be used intravenously as well as an intrathecal injection along with spinal anesthesia for surgery below the umbilicus.&#x0D; Materials and Methods: This was a prospective, randomized double blinded study, where 100 patients posted for elective lower limb surgery under spinal anesthesia were divided into two groups. Group A received 0.5% hyperbaric bupivacaine as spinal anesthesia along with intravenous infusion of 0.5 μg /kg/hour of dexmedetomidine over a period of ten minutes. Group B received 0.5% hyperbaric bupivacaine as spinal anesthesia along with intravenous normal saline over a period of ten minutes.&#x0D; Results: The onset of sensory block was 3.19 ± 0.31 minutes in group A whereas 4.5 ± 0.22 minutes in group B. The onset of motor block was 4.28 ± 1.02 minutes in group A whereas 7.12 ± 0.87 in group B. The onset and duration of sensory and motor block were statistically significant. Regarding duration of sensory block, group A had 186.5 ± 14.04 minutes whereas group B had 148.2 ± 11.31 minutes with p value &lt;0.001. The duration of motor block was 142 ± 11.42 minutes in group A whereas 122.4 ± 8.28 minutes in group B with p value &lt;0.001. The duration of postoperative analgesia was prolonged in group A when compared with group B.&#x0D; Conclusion: Dexmedetomidine used as a single intravenous injection along with spinal anesthesia with 0.5% bupivacaine tends to shortens the onset of both sensory and motor blocks and increases the duration of sensory and motor blocks. It also prolongs the duration of analgesia with minimal or no changes in hemodynamic parameters.

A Comparative Study between Dexmedetomidine, Clonidine and Fentanyl as Adjuvants to Bupivacaine in Ultrasound Guided Supraclavicular Brachial Plexus Block

Introduction: Supraclavicular brachial block is a popular and widely used nerve block technique for perioperative anesthesia and analgesia for upper extremity surgery. The block is performed at level of distal trunks and the origin of divisions, where the brachial plexus is confined to its smallest surface area, thus producing a rapid and reliable block of the plexus. It is the popular technique of anesthesia for upper limb surgeries due to its effectiveness in terms of performance, cost, margin of safety and good post-operative analgesia. It provides rapid onset, dense upper limb anesthesia with a single injection. Materials and Methods: About 90 patients who underwent elective upper limb Orthopaedics surgery during the period of the study were randomly divided into three equal groups of participants each using a computer-based random number generator, i.e., group C, D and F. They were compared for the onset and duration of motor and sensory block and post operative analgesia. Results: Mean onset of sensory and motor block was minimum for fentanyl (7.13 ± 0.94, 9.77 ± 0.82 minutes) followed by dexmedetomidine (7.37 ± 1.06, 11.33 ± 1.61 minutes) and clonidine (8.73 ± 0.98, 12.23 ± 1.57 minutes). Duration of block amongst the three groups showed statistically significant difference, dexmedetomidine (585.13 ± 44.42, 546.07 ± 42.02 minutes) having maximum duration of sensory and motor block followed by clonidine (535.77 ± 32.11, 507.30 ± 33.59 minutes) and minimum for fentanyl (330.03 ± 44.25, 284.67 ± 59.96 minutes). Conclusion: We concluded that adding fentanyl to bupivacaine for supraclavicular brachial plexus block had a faster onset of sensory and motor blockade when compared to dexmedetomidine and clonidine, and dexmedetomidine prolonged the duration of analgesia when compared with clonidine and fentanyl.

Use of Dexmedetomidine as an Adjuvant to Ropivacaine in Supraclavicular Brachial Plexus Block for Patients Undergoing Upper Limb Surgery

Background: Various adjuvants have been added in Brachial plexus block but only few studies have reported the use of dexmedetomidine. Alpha 2 agonist Dexmedetomidine used as an adjuvant to the local anesthetic has been suggested to prolong the duration of peripheral nerve block. The objective of this study is to compare the effect adding Dexmedetomidine to Ropivacaine in Supraclavicular brachial plexus block&#x0D; Materials and Methods: A Quantitative, comparative cross sectional prospective study was conducted in 78 patients randomly allocated into three groups. Group R received 30ml of 0.5% Ropivacaine, Group B received 30ml of 0.5% Ropivacaine + 50mcg of Dexmedetomidine for supraclavicular block and Group Y received 30ml of 0.5% Ropivacaine 0.5% for supraclavicular block and intravenous Dexmedetomidine 50mcg . The onset time to sensory and motor blockade, duration of sensory and motor block and duration of analgesia were recorded.&#x0D; Results: The onset of Sensory block and motor block was earlier in group B than in group Y and group R. The duration of sensory block and motor block duration was also prolonged in group B when compared with group Y and group R. The duration of analgesia was significantly longer in group B, and group Y when compared to group R.&#x0D; Conclusion: Dexmedetomidine as an adjuvant to Ropivacaine decreases the sensory as well as motor block onset time, prolongs sensory and motor block duration and also increases the duration of analgesia. The action of Dexmedetomidine most probably is local rather than centrally mediated.

Comparative Efficacy of Fentanyl Vs Dexmedetomidine Intrathecally as an Adjuvent to Isobaric Levo-Bupivacaine in Infra-Umbilical Surgery: A Prospective Randomized Study

Background: Fentanyl is a potent, highly lipophilic, synthetic opioid analgesic used as an adjuvant in spinal anaesthesia. Dexmedetomidine is also a potent, lipophilic, selective α2-adrenergic agonist. Compared to Dexmedetomidine, it has an earlier onset of block, better intraoperative analgesia with increased side effects(such as, nausea, vomiting or respiratory depression). Aim: To compare Fentanyl(25 ug) versus Dexmedetomidine(10 ug) as an adjuvant with 0.5% isobaric Levo-Bupivacaine in infra-umbilical surgeries. Material &amp; Methods: A prospective, randomized, controlled study. Department of Anaesthesia, K. D. Medical College, Hospital and Research Centre in Mathura. Patients between 20-60 years of either sex, ASA Grade I – II, scheduled for elective infra-umbilical procedures with no co-morbid conditions. Simple random method(sealed envelope). Results: The sensory block duration is 7.71±0.31 hrs in D group and 3.78±0.83 hrs in group F with p value &lt;0.05. The mean time taken for attaining motor blockade is 2.06 ± 1.17 mins in D group, 2.45 ± 1.39mins in F group. but statistically not significant between group D and in F group (p=0.2). The motor block duration is 7.33 ± 0.28hrs in group D and 3.39 ± 0.91 hrs in F group which suggestive of statistically highly significant (p=0.001). Conclusion: In infra-umbilical surgery, levo-Bupivacaine with adjuvant dexmedetomidine (10 ug) intrathecally has a longer duration of sensory and motor block with preserved hemodynamic stability and lesser adverse effects in comparison to adjuvant fentanyl(25 ug). However, onset of sensory block is earlier with fentanyl.