Onset Time Of Motor Blockade Research Articles

ADDITION OF DEXMEDETOMIDINETO LIGNOCAINE FOR INTRAVENOUS REGIONAL ANESTHESIA IN UPPER EXTREMITY ORTHOPAEDIC SURGERIES

Objective: The objective of this study was to determine the duration of onset and regression time of sensory and motor blocks, the quality of anesthesia, and post-operative analgesia by the addition of dexmedetomidine to local anesthetic solution in intravenous regional anesthesia (IVRA) in upper extremity orthopedic surgeries. Methods: This is a prospective, randomized, and double blind clinical trial. Ninety American Society of Anaesthesiologists Grade I and II patients of either gender between 18 and 60 years of age scheduled for elective upper extremity orthopedic surgeries lasting for <90 min were included in the study. Patients were randomly allocated to two Groups A and B of 45 each. Group A received 3 mg/kg preservative free lignocaine alone and Group B received 3 mg/kg preservative free lignocaine with dexmedetomidine, 0.5 μg/kg in IVRA. Result: Onset time of sensory blockade in Group A and B was 5.6±0.93 min and 3.9±0.63 min, respectively. Onset time of motor blockade in Group A and Group B was 15.01±4.53 min and 10.74±3.64 min, respectively. The difference in onset time of sensory and motor blockade between the two groups was statistically significant (p<0.05). Sensory blockade recovery time after release of tourniquet was 6.9±0.53 min in Group A and 29.21±5.23 min in Group B. Motor blockade recovery time was 4.35±0.76 min for Group A and 12.32±7.23 min for Group B. The difference in sensory and motor blockade recovery time between the two groups was statistically significant (p<0.05). Conclusion: Dexmedetomidine on addition to lignocaine for IVRA provided rapid onset of sensory and motor blockade, prolonged duration of sensory and motor blockade, and reduced tourniquet pain.

Single dose perioperative intrathecal ketamine as an adjuvant to intrathecal bupivacaine: A systematic review and meta-analysis of adult human randomized controlled trials

Study objectiveTo identify whether adding intrathecal ketamine to intrathecal bupivacaine prolongs the time to first analgesic request in adult humans. DesignA meta-analysis of randomized controlled trials in humans. SettingThe majority of data was obtained in an operating room and postoperative recovery area. PatientsA total of 750 ASA physical status I and II patients were included in the study. Procedures performed include: cesarean section, lower abdominal surgery, lower limb surgery, and urologic surgery. InterventionsDatabases including PubMed, Embase, Web of Science, and Cochrane were searched. Google Scholar was also queried. Multiple reviewers screened the papers for inclusion. MeasurementsThe primary outcome assessed was time to first analgesic request. Secondary outcomes included onset of sensory blockade, onset of motor blockade, duration of sensory blockade, and duration of motor blockade. Data were extracted to include means, 95% confidence intervals, tests for heterogeneity, and use of the Cochrane Collaboration guidelines to assess for publication bias. Main resultsEleven randomized controlled trials met inclusion criteria. When comparing intrathecal bupivacaine plus ketamine to intrathecal bupivacaine alone, the time to first analgesic request was prolonged (effect size = 58.23 min (95% CI 37.36 to 79.10) p < 0.0001). Secondary outcomes showed the onset time of sensory blockade was shortened (effect size = −0.87 min (95% CI -1.361 to 0.378) p = 0.0005), the onset time of motor blockade was reduced (effect size = −0.88 min (95% CI -1.77 to 0.013) p = 0.05), the duration of sensory blockade was prolonged (effect size = 39.73 min (95% CI 15.97 to 63.50) p = 0.001), and the duration of motor blockade was prolonged (effect size = 4.02 min (95% CI 3.27 to 4.78) p < 0.0001). Studies were shown to have high heterogeneity. Egger tests for all outcomes were non-significant and funnel plots assessing publication bias were all asymmetrical. ConclusionsThe studies analyzed suggest there may be a benefit to using intrathecal ketamine as an adjunct to bupivacaine. Additional studies are warranted to optimize dosing, clarify the safety and efficacy of this intrathecal drug combination, and examine the various ketamine formulations as intrathecal bupivacaine adjuvants.

COMPARISON OF TRAMADOLAS AN ADJUVANT TO INTRATHECAL ISOBARIC LEVOBUPIVACAINE FOR ELECTIVE LOWER LIMB SURGERIES UNDER SPINAL ANESTHESIA

Background: Long acting local anesthetics are used in subarachnoid block to increase the duration of anesthesia. Adjuvants are added to improve the duration of analgesia. The objective of this study was to evaluate the efcacy of tramadol as an intrathecal adjuvant to levobupivacaine in terms of duration of analgesia, onset of sensory blockade, onset of motor blockade, and duration of motor blockade. Methodology: After obtaining the Institutional Ethical Committee approval and informed consent, sixty patients posted for infraumbilical surgeries were recruited. Randomization was done using a sealed envelope technique. Patients were divided into two groups: LTreceived 2.5 ml of 0.5% isobaric levobupivacaine with tramadol 25 mg (0.5 ml) and LS received 2.5 ml of 0.5% isobaric levobupivacaine with 0.5 ml of normal saline. Duration of analgesia, onset of sensory blockade, and onset and duration of motor blockade were recorded. Results: There was no statistical difference in demographic data between the two groups. The mean onset time of sensory blockade in Group LS was 7.17±3.07 min and for Group LT was 8.53 ± 2.47 min, which was not statistically signicant between two groups (P = 0.064). The mean onset time of motor blockade in Group LS was 9.76 ± 3.18 min and for Group LT was 11.23 ± 2.47 min, which was statistically signicant between the two groups (P = 0.050). The mean time duration of analgesia in Group LS was 265.60± 39.18 min and for LT was 304.30 ± 24.88 min. There was mild prolongation of analgesia in Group LT, but it was statistically signicant (P &lt;0.001). The mean duration of motor blockade in Group LS was 197.93 ± 4.41 min and Group LT was 236.20 ± 33.89 min, which was statistically signicant between the two groups (P &lt;0.001). Conclusion: Tramadol as an adjuvant to isobaric intrathecal levobupivacaine does prolong analgesia signicantly.

The efficacy of nalbuphine versus fentanyl as additives to bupivacaine in spinal anesthesia for internal fixation of tibia: a double-blinded study

Background Spinal anesthesia is a well-established technique for lower limb surgeries. In the present study, intrathecal opioids were used in relatively high doses (nalbuphine 1.6 mg and fentanyl 50 µg) to prolong time of postoperative analgesia as an option of opioid-free postoperative analgesia. We compared the effects of intrathecal nalbuphine versus intrathecal fentanyl as adjuvants to bupivacaine, regarding the postoperative analgesia, the hemodynamic stability, and the onset and duration of sensory/motor block in patients undergoing internal fixation of tibia. Patients and methods The present study was carried out on 50 patients with American Society of Anaesthesiologists I or II scheduled for internal fixation of tibia under spinal analgesia, who were categorized into two groups: group F patients received intrathecal injection of 2 ml of 0.5% hyperbaric bupivacaine plus 1 ml fentanyl (50 µg) and group N patients received intrathecal injection of 2 ml of 0.5% hyperbaric bupivacaine plus 1 ml nalbuphine hydrochloride (1.6 mg). Results There was no significant difference between the two groups regarding the heart rate and mean arterial blood pressure, onset and duration of sensory block, and duration of motor block. Onset of motor block was significantly earlier in group F than group N (P=0.001). Duration of analgesia was significantly longer in group N when compared with group F (P=0.004). There was no significant difference in time of the first request analgesia and total dose of diclofenac sodium between the two groups. In the two studied groups, no cases experienced respiratory depression or bradycardia. Regarding hypotension, shivering, pruritus, nausea, and vomiting, no significant difference between the two studied groups was seen. Conclusion The addition of intrathecal nalbuphine 1.6 mg to spinal bupivacaine prolonged the onset time of motor blockade and duration of analgesia compared with the fentanyl intrathecal. Fentanyl in a dose of 50 µg and nalbuphine in a dose of 1.6 mg are safe adjuncts to bupivacaine.

A comparative study of epidural 0.5% isobaric levobupivacaine and epidural 0.5% isobaric levobupivacaine with dexmedetomidine for patients undergoing elective infraumbilical and lower limb surgeries

BACKGROUND: The quest for searching newer and safer anaesthetic agents has always been one of the primary needs in anaesthesiology practice. Regional anaesthesia techniques have seen numerous modifications over the last two decades with the advent of many newer and safer local anaesthetics Keeping these factors in mind, S (−)-enantiomer of bupivacaine, levobupivacaine has been developed. The advantages of levobupivacaine over bupivacaine are decreased cardiovascular toxicity and there is also a relatively decreased motor nerve fiber penetration and block, thereby a decreased post operative motor blockade and thus early ambulation of the patients can be achieved. The present study compared the effects of addition of epidural dexmedetomidine 50 micrograms to epidural 0.5% levobupivacaine for infraumbilical and lower limb surgeries. METHODS: Sixty patients of either sex belonging to ASA I & II in the age group of 25-45 years scheduled for infraumbilical and lower limb surgeries were randomly divided into 2 groups (30 each) to receive 0.5% isobaric levobupivacaine 20 ml epidurally with 0.5 ml distilled water (Group A) and 0.5% isobaric levobupivacaine 20 ml plus 0.5 ml dexmedetomidine containing 50 micrograms (Group B). This study evaluated the following parameters like time of onset of sensory blockade at T10 level, maximum sensory blockade achieved and time taken to achieve the same, onset time of motor blockade, degree of motor blockade, time taken to achieve maximal motor blockade, hemodynamic changes in pulse rate, blood pressure and oxygen saturation, side effects and complications, intraoperative sedation scores, duration of analgesia, sensory & motor blockade, and any postoperative adverse reactions. RESULTS: The data obtained from the above parameters were statistically analysed using SSPS version 16 software. Student t test was used for parametric data and Chi-square test for non parametric data. P<0.05 was considered as statistically significant. Maximal sensory level was achieved with addition of dexmedetomidine ranging from T4 to T6.Also the onset time of motor blockade was shortened with group A showing 19.33 minutes and group B showing only 14.5 minutes.The maximal motor blockade achieved was also intense (Bromage 3) with the addition of dexmedetomidine. Duration of analgesia, sensory and motor blockade were prolonged when levobupivacaine is combined with dexmedetomidine epidurally. Changes in hemodynamic parameters (blood pressure & heart rate) were very minimal in the dexmedetomidine group. Adverse effects experienced in general were statistically insignificant in both the groups. Mean sedation score in group B (Dexmedetomidine group) was predominantly found to be 2 as per Ramsay sedation score. None of the patients in group B had deep sedation or profound respiratory depression.

Evaluating the Efficacy of Tramadol as an Adjuvant to Intrathecal Isobaric Levobupivacaine for Elective Infraumbilical Surgeries.

Background:Long-acting local anesthetics are used in subarachnoid block to increase the duration of anesthesia. Adjuvants are added to improve the duration of analgesia.Settings:Randomized controlled trial was conducted in the Department of Anesthesiology in a tertiary care hospital.Aims and Objectives:The objective of this study was to evaluate the efficacy of low-dose tramadol as an intrathecal adjuvant to levobupivacaine in terms of duration of analgesia, onset of sensory blockade, onset of motor blockade, and duration of motor blockade.Methodology:After obtaining the Institutional Ethics Committee approval and informed consent, sixty patients posted for infraumbilical surgeries were recruited. Randomization was done using a sealed envelope technique. Patients were divided into two groups: LT received 3 ml of 0.5% isobaric levobupivacaine with tramadol 10 mg (0.2 ml) and LS received 3 ml of 0.5% isobaric levobupivacaine with 0.2 ml of normal saline. Duration of analgesia, onset of sensory blockade, and onset and duration of motor blockade were recorded.Results:There was no statistical difference in demographic data between the two groups. The mean onset time of sensory blockade in Group LS was 12.7 ± 9.81 min and for Group LT was 12.9 ± 0.81 min, which was not statistically significant between two groups (P = 0.93). The mean onset time of motor blockade in Group LS was 13.4 ± 10 min and for Group LT was 14.4 ± 10 min, which was no statistically significant between the two groups (P = 0.71). The mean time duration of analgesia in Group LS was 170.3 ± 59 min and for LT was 198.9 ± 57.33 min. There was mild prolongation of analgesia in Group LT, but it was not statistically significant (P = 0.0615). The mean duration of motor blockade in Group LS was 170.23 ± 58 min and Group LT was 190.76 ± 4 min, which was not statistically significant between the two groups (P = 0.14).Conclusion:Low-dose tramadol as an adjuvant to isobaric intrathecal levobupivacaine does not prolong analgesia significantly.

A Comparitive Study of Bupivacaine 0.5% versus Ropivacaine 0.5% for Supraclavicular Brachial Plexus Block in Adult Patients

Introduction: Peripheral nerve blocks have become important in clinical practice because of their role in post-operative pain relief, shortening of patient recovery time & avoiding risks and adverse effects of general anaesthesia. Bupivacaine is a long acting local anaesthetic. Due to its long duration of action and combined with its high quality sensory blockade compared to motor blockade it has been the most commonly used local anaesthetic for peripheral nerve blocks. Ropivacaine is a newer, long acting local anaesthetic whose neuronal blocking potential used in peripheral nerve blockade seems to be equal or superior to bupivacaine. Studies show that it has significantly greater safety margin over bupivacaine. Hence here is an attempt through the study to compare bupivacaine with ropivacaine in supraclavicular brachial plexus block in adult patients. Aims and Objectives: To compare the effect of bupivacaine 0.5% & ropivacaine 0.5% used for supraclavicular approach to brachial plexus block with respect to onset time of sensory blockade, onset time of motor blockade, duration of sensory blockade, duration of motor blockade, duration of analgesia, side effects/ complications. Method of Collection of Data: Sixty patients aged between 18 years and 60 years, of physical status ASA grade 1 and ASA grade 2 undergoing elective upper limb surgeries lasting more than 30 minutes were included in the study after getting ethical clearance. Each patient was randomly allocated to one of the two groups of 30 patients each. The patients were explained about the procedure and premedicated with tab alprazolam 0.5mg, and tab ranitidine 150 mg. The anesthetic technique employed was supraclavicular brachial plexus block using 30 ml of either 0.5% bupivacaine or 0.5% ropivacaine

The Analgesic Efficacy of Dexmedetomidine as an Adjunct to Local Anesthetics in Supraclavicular Brachial Plexus Block: A Randomized Controlled Trial.

This study was designed to assess the effects of dexmedetomidine on the onset and duration of block and postoperative analgesia during supraclavicular brachial plexus block in patients undergoing upper limb surgeries. Sixty adult patients undergoing upper limb and hand surgeries were randomly allocated into 2 groups. The control group received equal volumes of 0.75% ropivacaine and 2% lidocaine with adrenaline, whereas the dexmedetomidine (dexmed) group received 1 μg/kg dexmedetomidine along with equal volumes of 0.75% ropivacaine and 2% lidocaine with adrenaline. A total volume of 0.5 mL/kg was administered in ultrasound-guided supraclavicular brachial plexus block in both groups. Patients were observed for hemodynamic stability, onset and duration of sensory and motor blockade, duration of analgesia, postoperative pain, and adverse effects. The onset time of motor blockade was shortened and the duration of sensory, as well as motor, block was significantly prolonged in the dexmed group (P < 0.0001). The duration of postoperative analgesia was also longer in the dexmed group compared with the control group (median [interquartile range], 12 [10.5-13.5] hours and 17 [10.5-19.5] hours in control and dexmed group, respectively [95% confidence interval, -5 {-5, -4}, P < 0.0001]). The requirement for rescue analgesic during the 24-hour postoperative period was less in the dexmed group (P < 0.0001). Postoperative pain scores were comparable among groups except at 8 and 10 hours, when pain scores were lower in the dexmed group. Patients receiving dexmedetomidine were more sedated for 2 hours than the control group patients (P < 0.0001). No episode of bradycardia, hypotension, respiratory depression, or dizziness was reported. We conclude that the addition of dexmedetomidine to ropivacaine-lidocaine prolonged the duration of supraclavicular brachial plexus block and improved postoperative analgesia without significant adverse effects in patients undergoing upper limb surgeries.

Spinal anaesthesia with hyperbaric 0.5% bupivacaine: effects of volume.

Different volumes (1.5, 2, 3 and 4 ml) of hyperbaric 0.5% bupivacaine (8% glucose) were compared in spinal anaesthesia for urological surgery in 40 patients. The blockade was given with the patient in the sitting position. Two minutes after the injection the patient was placed in the lithotomy position. The time required for maximum cephalad spread of analgesia was about 20 min for all volumes. The maximum cephalad spread was directly related to log volume of the local anaesthetic solution. The onset time for motor blockade of the lower limbs decreased and the frequency increased with increasing volume. Four ml produced complete blockade in all patients. The duration of analgesia increased with increasing volume: 3-4 ml produced analgesia at T8 for 1.5-2.5 h and at L1 for 2-3 h. With this volume, complete motor blockade was obtained for 1.5-2.5 h. Satisfactory surgical anaesthesia for transurethral resection was obtained with 3-4 ml of the local anaesthetic solution.