Onset Time Of Motor Block Research Articles

Comparison between Intravenous and Perineural Dexamethasone in Prolonging the Analgesic Effect of Supraclavicular Plexus Nerve Block

Abstract Background poor controlled acute pain post-surgery is accompanied with several unwanted postoperative consequences, including patient agony, distress, myocardial ischemia, increased hospital stays and an increased possibility of post-operative chronic pain. Aim of the Work to study the effect of dexamethasone as a supplementary to bupivacaine in supraclavicular brachial plexus block. The comparison included the onset and the duration of the motor and sensory blocks, the duration of analgesia of the block and their effect on the postoperative analgesic needs. The effect of the drugs on hemodynamics and monitoring for the occurrence of any complication. Patients and Methods in our study, 50 patients were randomly divided into 2 equal groups. Perineural group received bupivacaine (0.5%) assosciated with 8 mg dexamethasone and Systemic group in which 8 mg of dexamethasone was injected systemically. All patients received equal volumes of 20 milliliters. Results our study revealed that adding 8 milligram of dexamethasone to bupivacaine in ultrasound-guided supraclavicular nerve block decreased the onset times of motor and sensory blocks and significantly increased their durations. In addition, dexamethasone prolonged the time of analgesia of the plexus block markedly, as shown by the time of request of first analgesia. Moreover, in perineural dexamethasone group, postoperative analgesic needs were much lesser than that of bupivacaine groups. Addition of dexamethasone perineural also did not affect the hemodynamics to a significant level. This makes perineural dexamethasone with bupivacaine more superior than the use of bupivacaine with addition of intravenous dexamethasone. Conclusion addition of Dexamethasone to bupivacaine in supraclavicular nerve block shortened the onset times of both sensory and motor blocks than injecting dexamethasone intravenously. Addition of Dexamethasone to bupivacaine significantly prolongs both sensory and motor block durations than injecting dexamethasone intravenously.

Dexamethasone with Local Anesthetics Versus Local Anesthetics Alone in Supraclavicular Brachial Plexus Block in Upper Limb Surgeries

Abstract Background Poorly controlled acute pain after surgery is associated with a variety of unwanted postoperative consequences, including patient suffering, distress, myocardial ischemia, prolonged hospital stays and an increased likelihood of chronic pain. Systemic analgesics (opioids and non-opioids) have long been used for postoperative pain, then neuroaxial or peripheral nerve blocks were employed. Local anesthetics alone were used, then various adjuvants were added to achieve quick, dense and prolonged block. Objective The aim of this study was to study the effect of dexamethasone as an adjuvant to bupivacaine in supraclavicular brachial plexus block. The comparison included the onset and the duration of the sensory and motor blocks, the duration of analgesia of the block as well as their effects on the postoperative analgesic requirements. The effect of the drugs on hemodynamics and monitoring the occurrence of any complication were also done. Patients and Methods In our study, 60 patients were randomly divided into 2 equal groups. Control group received bupivacaine only (0.5%) and dexa group in which 8 mg of dexamethasone were added to bupivacaine. All patients received equal volumes of 20 milliliters. Results Our study showed that addition of 8 milligrams of dexamethasone to bupivacaine in ultrasound-guided supraclavicular nerve block shortened the onset times of motor blocks and significantly prolonged motor and sensory block durations. In addition, dexamethasone prolonged the duration of analgesia of the plexus block significantly, as proved by the time of request of analgesia. Moreover, in dexa group, postoperative analgesic requirements were greatly lesser than that of bupivacaine groups. Addition of dexamethasone also did not affect the hemodynamics to a significant level. This makes dexamethasone with bupivacaine more superior than the use of bupivacaine alone. Conclusion Addition of dexamethasone to bupivacaine in supraclavicular nerve block shortened the onset motor blocks. Addition of dexamethasone to bupivacaine significantly prolongs of both sensory and motor block durations.

Efficacy of perineural versus systemic dexamethasone in prolonging analgesia after ultrasound guided femoral and sciatic nerve block for patients undergoing below knee surgeries

Abstract Background Poorly controlled acute pain after surgery is associated with a variety of unwanted postoperative consequences, including patient suffering, distress, myocardial ischemia, prolonged hospital stay and increase of chronic pain. Neuroaxial block is used for postoperative pain management and decrease analgesic use. Objective to compare the analgesic efficacy of both, intravenous and perineural administration of dexamethasone during femoral and sciatic nerve block using bupivacaine in patients undergoing below knee surgeries. Patients and Methods In our study, 50 patients were randomly divided into two equal groups: Group A (Perineural Dexamethasone group) [n = 25]: Those cases received 2ml volume of dexamethasone (8mg) combined with the 20 ml of bupivacaine of 0.5% concentration in each block, followed by injecting 5 ml saline intravenous. Group B (Systemic Dexamethasone group) [n = 25]: Those cases received 2 ml of dexamethasone (8mg) diluted over 3 cm saline in a 5 ml syringe following injection of the perineural 20 ml bupivacaine (0.5%) combined with 2 ml saline to have the same syringe volume for each block. Results Our study showed that onset time for sensory block was (25.39 ± 3.79) mins for systemic group and (18.85 ± 4.11) mins in perineural group with a significant statistical difference (P < 0.001) between both groups as the onset of sensory block in perineural group was significantly shorter than the systemic group and the duration of sensory block was (650.00 ± 62.8) mins in systemic group and (718.52 ± 62.06) mins in perineural group. The duration of sensory block was significantly shorter in systemic group than in perineural group with statistically high significant difference between groups (P < 0.001). Onset time for motor block was (30.61 ± 4.89) mins in systemic group and (27.59 ± 3.31) mins in perineural group. Perineural group had shorter time of onset than systemic dexamethasone group with a significant difference between groups (P = 0.013). The duration of analgesia was significantly longer in perineural group than systemic group (P < 0.001) Conclusion Dexamethasone was seen to be a potent adjunct to local anesthetic to prolong post operative analgesia with negligible side effects & better outcome to the perineural route.

Magnesium sulfate with Local Anesthetics versus Local Anesthetics Alone in Supraclavicular Brachial Plexus Block in Upper Limb Surgeries

Abstract Background Brachial plexus is a network of nerves that arises from the neck passing through the axilla to supply the whole upper limb with motor and sensory supply. Our target in upper limb surgeries is to block this plexus using local anesthetics. Different adjuvants have been mixed with local anesthetics (LAs) for peripheral nerve blocks (PNBs). These drugs usually affect may delay the onset of action and prolong the duration of analgesia. Objective The aim of the present study was to compare the effect of Magnesium with bupivacine vesus bupivacine alone in supraclavicular nerve block ultrasound guided in upper limb surgeries Patients and Methods In our study 82 patients are randomly divide into two equal groups, control group received only bupivacine 0.5 % and magnesium group received 250 mg in addition to bupivacine 0.5% Results Our study showed that addition of 150 mg of magnesium to bupivacine in ultra sound guided supraclavicular block prolong the onset time of both sensory and motor block (p value >0.05) non significant. But it significantly prolonged their duration, p value <0.05 for sensory block and <0.001 for motor block which was highly significant Conclusion Addition of magnesium also did not affect the hemodynamics as regard systolic, diastolic blood pressure and o2 saturation. The previous findings proved that adding magnesium to bupivacine is more superior than the use of bupivacine alone.

Comparison of the ED50 of intrathecal hyperbaric ropivacaine co-administered with or without intrathecal dexmedetomidine for cesarean section: A prospective, double-blinded, randomized dose-response trial using up-down sequential allocation method

Study objectiveStudies have showed that intrathecal dexmedetomidine as supplements to local anesthetics can improve the quality of the spinal anesthesia and reduce the local anesthetic requirement of spinal anesthesia for cesarean section. However, the magnitude of this effect has not been fully quantified. Therefore, we conducted the present study to investigate the ED50 of intrathecal hyperbaric ropivacaine with or without dexmedetomidine for cesarean section in healthy parturients. ED50 values obtained were compared to estimate the effect of intrathecal dexmedetomidine versus placebo on ropivacaine requirement. DesignSingle-blinded, prospective, randomized study. SettingDepartment of Anesthesia, Women's Hospital, Zhejiang University School of Medicine. PatientsSixty healthy parturients under elective cesarean section with combined spinal-epidural anesthesia were randomized into Group C (intrathecal ropivacaine alone) and Group D (intrathecal ropivacaine + 5 μg dexmedetomidine). InterventionsThe dose of intrathecal ropivacaine for the first parturient in both groups was 11 mg. An increment or decrement of 0.5 mg intrathecal ropivacaine was made for the subsequent parturient based on the effective or ineffective response of the previous parturient. Effective dose was defined as a bilateral T6 or above sensory block level was achieved within 15 min after induce of spinal anesthesia and no additional epidural anesthetics was required during surgery. The Dixon and Massay sequential method and Probit regression were applied to calculate the ED50 of intrathecal ropivacaine in both groups. MeasurementsCharacteristics of spinal anesthesia and side effects were recorded. Main resultsThe ED50 of hyperbaric ropivacaine calculated by Dixon and Massay formula was 11.4 mg (95% CI, 11.1–11.7 mg) in Group C, and 9.4 mg (95% CI, 9.0–9.7 mg) in Group D (P < 0.05). While using the Probit regression, the ED50 of intrathecal hyperbaric ropivacaine was 11.1 mg (95% CI, 10.7–11.6 mg) in Group C, and 9.1 mg (95% CI, 8.6–9.5 mg) in Group D. Shivering was less observed in Group D than in Group C (P < 0.05). There was no significant difference in the onset time of sensory block or motor block, the incidence of hypotension, bradycardia, nausea and vomiting, sedation and pruritus between the two groups. ConclusionUnder the conditions of the present study, intrathecal dexmedetomidine (5 μg) reduced the ED50 of intrathecal hyperbaric ropivacaine by approximately 18% for cesarean section in healthy parturients under combined spinal-epidural anesthesia.

COMPARISON OF CLONIDINE AND DEXMEDETOMIDINE AS AN ADJUVANT TO 0.5% BUPIVACAINE IN SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK: A RANDOMISED PROSPECTIVE DOUBLE-BLIND STUDY

Background and Objectives: Alpha-2 agonists are used as adjuvant with local anaesthetic agents to prolong the duration of spinal, epidural and peripheral nerve blocks as well as to prolong the duration of post operative analgesia. We performed a study to compare clonidine(1ug/kg) and dexmedetomidine (1ug/kg) as an adjuvant to 0.5% bupivacaine in supraclavicular brachial plexus block.&#x0D; Methods: Eighty ASA I and II patients scheduled for elective upper limb orthopaedic surgeries under supraclavicular brachial plexus block were divided into two groups(n=25 each) in a randomized, double-blinded fashion. Group C received clonidine 1 μg/kg and Group D received dexmedetomidine 1 μg/kg added to bupivacaine 0.5% (30 cc). Onset and recovery time of sensory and motor block, as well as duration of analgesia were studied in both the groups.&#x0D; Results: Duration of sensory block and motor block was 220.12 ±50.3 and 280.1± 20.12 min respectively in group C, while it was 410.34± 60.12 and 460.4 ± 50.56 min respectively in group D and hence both were significantly prolonged in group D. No statistically significant difference was seen in onset of sensory and motor block between the two groups. The duration of analgesia i.e. time to requirement of rescue analgesia was 270.4± 56.7 mins and 452.7 ±64.23 mins in group C and D respectively and this difference was statistically significant (P=0.001).&#x0D; Conclusion: Addition of dexmedetomidine to bupivacaine 0.5% in supraclavicular brachial plexus block prolonged the duration of sensory and motor block as well as the duration of analgesia when compared with clonidine.&#x0D; Keywords: Clonidine, dexmedetomidine, supraclavicular block

The Comparison of Intrathecal Ropivacaine with Bupivacaine for Knee Arthroscopy: A Meta-analysis of Randomized Controlled Trials

The comparison of intrathecal ropivacaine with bupivacaine for knee arthroscopy remains controversial. We conduct a systematic review and meta-analysis to explore the efficacy of intrathecal ropivacaine versus bupivacaine for knee arthroscopy. We search PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through August 2019 for randomized controlled trials (RCTs) assessing the effect of intrathecal ropivacaine versus bupivacaine for knee arthroscopy. This meta-analysis is performed using the random effects model. Five RCTs are included in the meta-analysis. Overall, compared with intrathecal bupivacaine for knee arthroscopy, intrathecal ropivacaine is associated with increased onset time of motor block (mean difference [MD] = 2.05, 95% CI: 1.43-2.67, p < 0.00001) and decreased duration of sensory block (MD = -26.82, 95% CI: -31.96 to -21.67, p < 0.00001) but shows no remarkable influence on onset time of sensory block (MD = -0.09; 95% CI: -1.89 to 1.70, p = 0.92), duration of motor block (MD = -59.76; 95% CI: -124.44 to 4.91, p = 0.07), time to maximum block (MD = 2.35; 95% CI: -0.16 to 4.86, p = 0.07), first urination time (MD = -26.42, 95% CI: -57.34 to 4.51, p = 0.09), or first ambulation time (MD = 3.63, 95% CI: -25.20 to 32.47, p = 0.80).Intrathecal ropivacaine can substantially increase onset time of motor block and decrease the duration of sensory block than intrathecal bupivacaine for knee arthroscopy.

Comparative study of subarachnoid injection of dexmedetomidine versus magnesium sulfate as adjuvants to bupivacaine in patients undergoing classical repair surgery

Background Spinal anesthesia has several benefits over general anesthesia. Addition of adjuvants to local anesthetics improves the quality of the subarachnoid block. Objective We attempted to improve the quality of spinal anesthesia by the addition of magnesium sulfate or dexmedetomidine to intrathecal bupivacaine in patients undergoing classical repair surgery as regards primary outcome (quality of spinal anesthesia) and secondary outcomes (effect on hemodynamics and incidence of complications). Patients and methods This prospective randomized double-blinded controlled clinical study was carried out on 75 adult female patients scheduled for classical repair surgeries under spinal anesthesia who were assigned into three equal groups. Group D: 15 mg of 0.5% hyperbaric bupivacaine plus 10 μg dexmedetomidine was given to the patients. Group M: patients received 15 mg of 0.5% hyperbaric bupivacaine plus 0.5 ml magnesium sulfate (50 mg). Group C: patients received 15 mg of 0.5% hyperbaric bupivacaine plus 0.5 ml normal saline as control. The comparison was made among the three groups in regards to onset time of sensory and motor block, degree of postoperative pain relief, effect on hemodynamic stability, and total postoperative morphine consumption, and complications were recorded. Results There was a statistical difference among the three groups as regards the onset time of both sensory and motor block, which was faster in group D than in group C, and both were faster than group M. The duration of postoperative analgesia was significantly prolonged in D and M groups compared with the control group. The requirements of morphine sulfate in the first 24 h were significantly lower in the D and M groups compared with the control group. Conclusion Subarachnoid dexmedetomidine supplementation of spinal block was found to be a better option than intrathecal magnesium sulfate in patients undergoing classical repair surgeries, as it provides rapid onset of sensory and motor block; also, it improves the quality of postoperative analgesia and reduces postoperative analgesic requirements.

Ultrasound-guided femoro–sciatic nerve block with and without using nerve locator for below-knee surgeries

Background Femoral and sciatic nerve blocks is a suitable technique for below-knee surgeries compared with neuroaxial and general anesthetic techniques. Objectives To evaluate the efficacy of ultrasound-guided femoral and sciatic nerve blocks with and without using a nerve locator in below-knee surgeries. Patients and methods Between May 2017 and May 2018, we conducted our randomized, observer-blinded prospective clinical study. Sixty patients underwent below-knee surgeries in Menoufia University Hospitals were involved and divided into two groups of 30 patients each. The groups were assigned into two: group A received ultrasound-guided femoral and sciatic nerve block and in group B, nerve block was done using combined ultrasound with a nerve locator. Results The onset time of motor block was significantly shorter in the nerve locator group than in the ultrasound-only group (P Conclusion Adding nerve locator to the ultrasound-guided nerve block technique has minimal impact on the efficacy of the technique.

Fentanyl versus dexmedetomidine with bupivacaine in ultrasound-guided supraclavicular block in hemodialysis shunt surgeries

Background Ultrasound-guided supraclavicular brachial plexus block provides perfect option for patients with end-stage renal disease undergoing arteriovenous fistula for hemodialysis. Purpose To evaluate and compare the effects of adding fentanyl to bupivacaine versus bupivacaine with dexmedetomidine in ultrasound-guided supraclavicular brachial plexus block for shunt surgeries in chronic renal failure regarding the efficacy of block and possible adverse effects. Patients and methods A total of 30 adult patients with end stage renal disease (ESRD) admitted for shunt surgery in the arm or forearm under ultrasound-guided supraclavicular brachial plexus block were randomly assigned into two equal groups (15 patients each) according to adjuncts added to bupivacaine, either fentanyl or dexmedetomidine. The demographic data of the patients were recorded, and block characteristics were categorized according to sensory block onset time and duration and motor block onset time and duration. The hemodynamics, duration of analgesia, time of first analgesic administration, total dose of analgesics used, visual analogue scale score, Ramsay sedation score, and complications were recorded and subjected to statistical analysis. Results Both dexmedetomidine and fentanyl provide rapid onset and prolonged duration of both sensory and motor block but more with dexmedetomidine, and the results were statically significant. There is also a statistically significant difference in the duration of analgesia and sedation score in the side of dexmedetomidine. Demographic data and duration of surgery were not statistically significant between the two groups. Conclusion Addition of dexmedetomidine to bupivacaine to supraclavicular brachial plexus block provides more favorable condition for surgery than fentanyl, more duration of analgesia, and better sedation, with less hemodynamic variability and low incidence of complications.

A comparative study of the effect of intrathecal tramadol and buprenorphine used as adjuvants to hyperbaric bupivacaine for postoperative analgesia in infraumbilical surgeries

Background &amp; Objective: The augmentation of local anesthetics with various adjuvants to enhance the quality and efficacy of subarachnoid block is clinically in practice since long. Comparative studies on effects of adding intrathecal tramadol and buprenorphine has never been studied before. Both drygs are esily available in our country. So, we conducted this study to evaluate and compare the characteristics of subarachnoid blockade, duration of postoperative analgesia, dose of recue analgesic postoperatively, and adverse effects of intrathecal buprenorphine (50 μg) and intrathecal tramadol (30 mg) as adjuvants to 0.5% hyperbaric bupivacaine for lower abdominal surgeries Methodology: This prospective randomized, single blind controlled trial was carried out at Services Hospital Lahore, from January to July 2018. 110 American society of Anesthesiologist I - II male patients, 35 to 45 y of age undergoing subarachnoid block for infra-umbilical surgery were randomized into two groups. Group T (n = 55) patients received 10 mg of 0.5% bupivacaine and 30 mg of tramadol intrathecally, while group B (n = 55) received 10 mg 0.5% bupivacaine with 50 μg of buprenorphine. Sensory testing was done by pin prick method using 25G blunt needle and time taken to reach T10 level noted. Motor block was assessed using Modified Bromage Scale. The time taken to reach modified Bromage 3 was recorded. Side effects and postoperative analgesia noted for 24 h by VAS score every 20 min for first 2 h in PACU and then 4 hourly for 24 h in the ward. Patients with inadequate block were converted into general anesthesia and were excluded from the study. Time to first rescue analgesia, and total analgesic required in 24 h were compared in two groups.Results: Mean VAS scores were less in Group T as compared to Group B. Significant difference was seen among groups at 45 min (p = 0.04), 60 min (p = 0.02), 75 min (p = 0.03), 90 min (p = 0.01), 120 min (p = 0.00), 4h (p = 0.007), 8 h (p = 0.01), 12 h (p = 0.01), 16 h (p = 0.00). After 24 h no significant difference was seen in both groups. Mean onset time for sensory block was earlier in Group B (2.4 min) compared to Group T (2.7 min)(p = 0.001). Mean onset time for motor block was earlier in Group B (4.8 min)as compared to Group T (5.5 min)(p = 0.00). No significant difference was seen among groups in side effects (p &gt; 0.05). Mean time for rescue analgesia in Group B was earlier (4.51 ± 2.8 h.) as compared to Group T (4.94 ± 4.1h). Total dose of analgesic given in 24 h was significantly less in group T. (p = 0.004) The mean dose given in Group B (1.24 ± 0.96 mg/kg) was greater than Group T (0.76 ± 0.71 mg/kg)Conclusion: We conclude that both tramadol and buprenorphine, prolong the duration of postop analgesia without adding any adverse effects, but duration with tramadol is longer; it significantly reduces VAS and the dose of analgesic requirement in 24 h postoperatively.IRB letter No. IRB/2018/427/SIMS Citation: Siddiq S, Asad N, Rehman AU, Ali M, Khalid HMU, Butt Z. A comparative study of the effect of intrathecal tramadol and buprenorphine used as adjuvants to hyperbaric bupivacaine for postoperative analgesia in infraumbilical surgeries. Anesth pain &amp; intensiv care 2019;23(3):263-267

Randomised Control Trial Comparing Plain Levobupivacaine and Ropivacaine with Hyperbaric Bupivacaine in Caesarean Deliveries.

The study compared spinal block characteristics of equipotent doses of plain 0.5% levobupivacaine, plain 0.75% ropivacaine and hyperbaric 0.5% bupivacaine for elective caesarean (CS) delivery. A total of 100 parturient women undergoing elective CS under spinal anaesthesia were enrolled for the study. The parturients were randomly assigned to receive one of the following in a subarachnoid block: hyperbaric 0.5% bupivacaine 10 mg (group B), plain 0.5% levobupivacaine 10 mg (group L), or plain 0.5% ropivacaine 15 mg (group R). Motor block duration [groups B, LB, R: 143.78 (30.43) minutes, 139.31 (33.38) minutes, 137.32 (27.39) minutes, respectively; P=0.80], sensory block duration [groups B, LB, R: 122.87 (34.93) minutes, 113.03 (39.24) minutes, 125.58 (24.93) minutes, respectively; p=0.30] and first analgesic request time [groups B, LB, R: 136.87 (28.70) minutes, 133.59 (27.30) minutes, 144.19 (32.09) minutes, respectively; p=0.35] were statistically comparable. The groups were statistically comparable for sensory block onset time [T6 block; groups B, LB, R: 4.62 (2.80) minutes, 4.93 (2.63) minutes, 5.73 (3.00) minutes, respectively; p=0.29] but motor block onset time was statistically prolonged for group R as compared to group B [Bromage 3 block; group B, LB, R: 5.93 (3.41) minutes, 9.00 (4.00) minutes, 10.16 (5.66) minutes, respectively; p=0.001]. No statistically significant differences were seen in sensory and motor block recovery times, haemodynamic parameters or side-effects. The anaesthesia from a spinal block with 10 mg plain levobupivacaine or 15 mg plain ropivacaine is comparable to the anaesthetic effect of 10 mg hyperbaric bupivacaine in elective caesarean deliveries.

Comparison of Mean Onset of Motor and Sensory Block of Isobaric Ropivacaine and Hyperbaric Bupivacaine for Elective Caesarean Sections at Tertiary Care Hospital, Karachi.

Objective: To compare the mean onset time of motor and sensory block of Isobaric Ropivacaine and Hyperbaric Bupivacaine for elective caesarean sections at Tertiary Care Hospital, Karachi.&#x0D; Methods: A double blinded Randomized control trial study carried out over the period of six months, from August 2016 to January 2017 using non probability consecutive sampling technique. A total of 128 pregnant women planned for LSCS under spinal anesthesia were enrolled in this study. Patients were randomly divided into two groups (Group B and Group R) receiving equipotent doses of spinal anaesthetic drugs. In group B, spinal anaesthesia were given to 64 patients with intrathecal injection of 3ml of 0.5% (5mg/ml) Hyperbaric Bupivacaine and in group R, 64 patients received spinal anaesthesia using 3ml of 0.5% (5mg/ml) Isobaric Ropivacaine. Motor block was evaluated by using Modified Bromage scale score and a score of &gt;2 is consider as optimal motor nerve block. Sensory block was evaluated by using 25G needle pinprick method along the mid clavicular line bilaterally and sensory block (loss of sensation to pain) at T6 level is consider as optimal sensory nerve block. At 10 minutes, Final outcome for each group B and R will be labelled in term of mean time of achievement of motor and sensory block and two dermatomal sensory segment regression.&#x0D; Results: Out of 128 patients, 64 patients receiving spinal anaesthesia using Hyperbaric Bupivacaine the mean duration to achieve sensory nerve block at T6 Level is found to be faster as compare to Isobaric Ropivacaine while the mean onset time of motor nerve block was also considerably significant in between the two groups (p=0.049).The Regression time of maximum sensory block from two dermatomal skin level is also found to be earlier in Isobaric Ropivacaine as compare to patients receiving spinal anaesthesia with Hyperbaric Bupivacaine (130.34 ± 15.26 vs 146.41 ± 12.81; p-value=0.0005). These regional anaesthetic properties of Isobaric Ropivacaine makes it a safer regional anaesthetic agent as Hyperbaric Bupivacaine.&#x0D; Conclusion: Spinal anaesthesia using intrathecal Ropivacaine for elective caesarean sections is an effective and optimal drug of choice. Two Dermatomal Sensory Regression was also found to be earlier in Isobaric Ropivacaine thus ropivacaine provides surgically effective anaesthesia of shorter duration and early sensory onset without compromising neonatal outcome and maternal hemodynamics.&#x0D;

Comparing Postoperative Analgesic Effect of Dexmedetomidine or Dexamethasone Added to Lidocaine Through Infraclavicular Block in Forearm Surgery.

The objective of this study was to compare the analgesic efficacy of dexamethasone versus dexmedetomidine added to lidocaine using infraclavicular block in patients undergoing forearm fracture surgery. Seventy-five patients aged 20 to 60 years were recruited for a prospective, double-blinded, randomized clinical trial. Ultrasound-guided infraclavicular brachial plexus block was performed in 3 groups by injecting 28 mL lidocaine plus 2 mL distilled water (Lido), 28 mL lidocaine plus 2 mL (8 mg) dexamethasone (Dexa), and 28 mL lidocaine plus 2 mL (1 µg/kg) dexmedetomidine (Dexm). Sensory and motor block onset time and the duration, hemodynamic variables, the time for the first analgesic request, and the total analgesic agents consumed within 6 hours after infraclavicular block were assessed. Sensory block duration in the Dexm group was significantly greater than in the Lido (P=0.019) and Dexa (P=0.046) groups. The mean motor block duration in the Dexm group showed to be significantly longer than that in the Lido group (P=0.009). Pain intensity within 4 hours after block significantly increased in the Lido group compared with that in the Dexa and Dexm groups (P=0.001). Analgesic consumption during 6 hours after the procedure was higher in the Lido group when compared with the other 2 groups (P=0.001). The Dexm group showed the highest reduction in the mean arterial pressure (P=0.006) and heart rate (P=0.001) among the 3 groups. There was no significant difference in postoperative pain intensity between the Dexa and Dexm groups, although DEXm demonstrated a longer sensory block duration in comparison with dexamethasone as a lidocaine adjuvant in infraclavicular block.

A comparative study of isobaric levobupivacaine 0.5% versus isobaric levobupivacaine 0.5% with 3mcg dexmeditomidine in spinal anaesthesia

Intrathecal α2 agonists prolong the duration of action of local anesthetics and reduce the required dose. Dexmedetomidine is an α2 receptor agonist and its α2/α1 selectivity is 8 times higher than that of clonidine. In this study, we aimed to investigate the effect of adding dexmedetomidine to intrathecal Isobaric levobupivacaine 0.5% on the onset time and duration of motor and sensory blocks. Patients were randomly assigned into two groups. Group L (n= 30) patients received 3 mL (15 mg) of 0.5% levobupivacaine +0.3 mL normal saline and Group LD (n= 30) patients received 3 mL (15 mg) of 0.5% levobupivacaine + 0.3 mL (3 μg) dexmedetomidine. Sensory block onset time, block reaching time to T10 dermatome, the most elevated dermatome level, two dermatome regression time, sensory block complete regression time as well as motor block onset time, reaching Bromage 3 and regressing to Bromage 0 were recorded. Sensory and motor block onset times were shorter in Group LD than in Group L (p

COMPARATIVE STUDY BETWEEN DEXMEDETOMIDINE AND FENTANYL AS AN ADJUVANT TO BUPIVACAINE IN ULTRASOUND-GUIDED INTERSCALENE BRACHIAL PLEXUS BLOCK IN ARTHROSCOPIC SHOULDER SURGERIES

Background: Poorly controlled acute pain after shoulder surgery is associated with a variety of unwanted post-operativeconsequences, including patient suffering, prolonged hospital stays and an increased likelihood of chronic pain. The interscalene block is the gold standard for shoulder anesthesia and the most commonly used block for shoulder procedures. Aim of the work: to compare the effects of adding either 100 micro-grams of dexmedetomidine or 50 micro-grams of fentanyl to bupivacaine in ultrasound-guided interscalene nerve block, as regards the onset and the duration of the sensory and motor block, and the duration of post-operative analgesia. Patients M Group C: 25 patients received a total volume of 30 ml bupivacaine 0.5%. Group D: 25 patients received a total volume of 30 mlbupivacaine 0.5% added to 100 micrograms of dexmedetomidine, Group F: 25 patients received a total volume of 30 ml bupivacaine 0.5% added to 50 micrograms of fentanyl. Results: This study showed that addition of a 100 micro gram ofdexmedetomidine to bupivacaine in interscalene nerve block shortens the onset times of sensory and motor block and prolongs their duration in comparison to 50 micro-gram of fentanyl when added to bupivacaine, and to bupivacaine when used alone, also dexmedetomidine got and added effect of conscious sedation with minimal side effect. Conclusions: Our study showed that addition of dexmedetomidine to bupivacaine in interscalene nerve block shortened the onset times ofboth sensory and motor blocks and prolonged their durations. This occurred in comparison to fentanyl when added to bupivacaine and to bupivacaine when used alone.

Combined ultrasound and nerve stimulator-guided deep nerve block may decrease the rate of local anesthetics systemic toxicity: a randomized clinical trial

BackgroundUltrasound guidance might decrease the incidence of local anesthetics systemic toxicity (LAST) for many peripheral nerve blocks compared with nerve stimulator guidance. However, it remains uncertain whether ultrasound guidance is superior to nerve stimulator guidance for deep nerve block of the lower extremity. This study was designed to investigate whether deep nerve block with ultrasound guidance would decrease the incidence of LAST compared with that with nerve stimulator guidance, and to identify associated risk factors of LAST.MethodsThree hundred patients undergoing elective lower limb surgery and desiring lumbar plexus blocks (LPBs) and sciatic nerve blocks (SNBs) were enrolled in this study. The patients were randomly assigned to receive LPBs and SNBs with ultrasound guidance (group U), nerve stimulator guidance (group N) or dual guidance (group M). The primary outcome was the incidence of LAST. The secondary outcomes were the number of needle redirection, motor and sensory block onset and nerve distribution restoration time, as well as associated risk factors.ResultsThere were 18 patients with LAST, including 12 in group U, 4 in group N and 2 in group M. By multiple comparisons among the three groups, we found that the incidence of LAST in group U (12%) was significantly higher than that in group N (4%)(P = 0.037) and group M(2%)(P = 0.006). The OR of LAST with hepatitis B (HBV) infection and the female sex was 3.352 (95% CI,1.233–9.108, P = 0.013) and 9.488 (95% CI,2.142–42.093, P = 0.0004), respectively.ConclusionsUltrasound guidance, HBV infection and the female sex were risk factors of LAST with LPBs and SNBs. For patients infected with HBV or female patients receiving LPBs and SNBs, we recommended that combined ultrasound and nerve stimulator guidance should be used to improve the safety.Trial registrationThis study was approved by the Ethical Committee of the First Affiliated Hospital of Army Medical University. The protocol was registered prospectively with the Chinese Clinical Trial Registry (ChiCTR-IOR-16008099) on March 15, 2016.

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

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

Ultrasonografi Kılavuzluğunda İnfraklaviküler Blok ile Üst Ekstremite Ortopedi Cerrahisi Geçiren Hastalarda Midazolam ve Deksmedetomidin ile Sedasyonun Periferik Sinir Bloğu Üzerine Etkilerinin Karşılaştırılması

Objective: Sedation is an important step of regional anesthesia, the effects of sedative agents on nerve block characteristics are often subjects of scientific researches. In our study, we aimed to compare the effects of dexmedetomidine and midazolam sedation on sensory and motor onset and termination time after infraclavicular nerve block. Material and Methods: After local ethics committee approval and patients written informed consents were obtained, 60 patients between the ages of 18-65 years, with an American Society of Anesthesiologists (ASA) classification I-II who received infraclavicular nerve block randomized into two groups. Group D received 0.8 μg/kg bolus continued with 0.2-0.7 μg/kg/h of maintenance dose of dexmedetomidine group M received 0.05mg/kg bolus continued with 0.02-0.2 mg/kg/h of maintenance dose of midazolam. The patient's demographic data heart rate pulse, mean arterial pressure, sensory and motor block onset and termination time were analyzed. Results: Heart rate and mean arterial pressure were lower in dexmedetomidine group. Sensory (Group D: 8.6±2.4 Group M: 16.2±1.8) and motor block onset time (Group D: 14.2±1.6, Group M: 21.4±2.3) was shorter in dexmedetomidine group. Sensory (Group D: 715.4±41.1 min Group M: 518.1±44.2 min) and motor block termination time (Group D: 613.6±38.1 min Group M: 421.3±37.2 min) were longer in dexmedetomidine group. Conclusion: The use of dexmedetomidine for sedation on patients who received ultrasound-guided infraclavicular block for upper extremity surgeries resulted earlier onset time to sensory and motor block and prolonged sensory and motor block termination time.

Ultrasound-guided popliteal sciatic and adductor canal block for below-knee surgeries in high-risk patients

Background and Aims:Central neuraxial block and general anaesthesia in patients with significant comorbidities are associated with considerable peri-operative morbidity and mortality. This study aims to delineate peripheral nerve block as a suitable alternative technique in high-risk patients posted for below-knee surgery.Methods:Twenty patients with the American Society of Anesthesiologist's (ASA) physical status grade III and IV, aged 30–80 years, scheduled for below-knee surgery from May 2018 to February 2019 were enrolled in this prospective study. All patients received ultrasound-guided popliteal sciatic block with 20 ml 0.5% ropivacaine and adductor canal block with 10 ml 0.375% ropivacaine. The peripheral nerve block success rate, sensory and motor block onset time, haemodynamic parameters, duration of post-operative analgesia and patient's satisfaction were recorded. Descriptive statistics of the study were calculated and the data was analysed using an SPSS statistics 21.0 program.Result:Surgery was performed successfully with no additional analgesic requirement in all patients. The mean duration for sensory and motor block onset time was 3.35 ± 0.49 (mean ± standard deviation) and 4.65 ± 0.48 (mean ± standard deviation) minutes respectively. Haemodynamic parameters were maintained stable throughout the procedure. The average duration of postoperative analgesia was 7.5 ± 0.8 (mean ± standard deviation) hours. Patient overall satisfaction as assessed, by three-point Lickert's scale, was satisfactory.Conclusion:Ultrasound-guided combined popliteal sciatic and adductor canal block is an effective alternative anaesthetic technique for below-knee surgeries with stability of haemodynamic parameters and pain management in high-risk patients.