Prolonged Duration Of Analgesia Research Articles

Comparison of two different doses of magnesium sulfate as an adjuvant to intrathecal bupivacaine in patients with pre-eclampsia undergoing elective cesarean section: A prospective double-blind randomized study

Background: Intrathecal magnesium sulfate is now emerging as a safe and effective adjuvant for spinal anesthesia (SA). The aim of the present study was to compare the efficacy of two doses of intrathecal magnesium in parturients with pre-eclampsia. Methods: This prospective randomized double-blind study was conducted on 105 parturients undergoing elective cesarean section (CS) who were randomized into three groups of 35 each: Group C, M50, and M75. Group M50 and group M75 received 50 mg of 50% (0.1 ml) and 75 mg of 50% (0.15 ml) magnesium sulfate, respectively. All of the groups received 10 mg of 0.5% heavy bupivacaine with normal saline accordingly to make a total volume of 2.2 ml. The sensory and motor block characteristics, visual analogue scale (VAS) score, post-operative analgesic requirements, hemodynamic parameters, and adverse effects were compared. Results: The sensory and motor block characteristics were significantly delayed in group M75 compared to group M50 and the control group (P < 0.05). VAS scores were significantly high in the control group up to 6 h as compared to group M50 and group M75 (P < 0.05). The time to first rescue analgesia was significantly extended in group M75 (222.86 ± 12.502 min) as compared to group M50 (221.14 ± 13.671 min) and the control group (127.43 ± 11.464 min) (P < 0.05) Conclusion: Intrathecal magnesium sulfate at doses of 50 mg and 75 mg in pre-eclamptic parturients undergoing elective CS results in prolonged duration of analgesia, decreased VAS scores and also delays the first rescue analgesic requirement with a favorable adverse effect profile in terms of decreased incidence of nausea and shivering.

Combined psoas compartment block and sciatic nerve block versus unilateral subarachnoid block as a sole anaesthetic technique for lower limb orthopaedic surgery – A prospective randomised controlled study

: Nerve block as a part on regional anaesthesia extends analgesia time and gives better haemodynamic stability, so comparison of nerve block like psoas compartment block and sciatic nerve block with spinal anaesthesia is our main aim of study. Total 96 patients of tibial surgeries with any gender of ASA grade I, II and III were assigned and randomly divided into two groups:- group P- psoas compartment block plus sciatic nerve block and group S-unilateral subarachnoid block. Parameters compared were onset, peak effect and duration of sensory and motor blockage, haemodynamic parameters, postoperative duration of analgesia and requirement of rescue analgesics post-operatively. Onset of motor and sensory block were faster in group S than group P. There was no significant difference in haemodynamic parameters in both the group. Duration of analgesia in group P was 16.79 ±2.3 hours as compared to group S was 5.57 ±0.49 hours, which was highly significant. Number of rescue analgesic required was significantly less in group P(1.10 ± 0.30) as compared to group S (3.04 ± 0.20) without significant complications in both the groups.Combined psoas compartment block with sciatic nerve block provides prolonged duration of analgesia over subarachnoid block and less numbers of rescue analgesics required postoperatively with good haemodynamic stability.

Comparison of the Analgesic Efficacy of Ultrasound-Guided Superficial Serratus Anterior Plane Block With Deep Serratus Anterior Plane Block in Patients Undergoing Modified Radical Mastectomy: A Randomized Clinical Trial.

Background Acute postoperative pain after breast cancer surgery adversely affects recovery and is an independent predictor of chronic postsurgical pain in these patients. Serratus plane blocks have been found to provide analgesia to the anterior hemithorax. However, trials comparing superficial serratus plane block and deep serratus block in breast cancer surgery patients are sparse. Methodology A total of 74 female patients with American Society of Anesthesiologists physical status I and II scheduled for elective modified radical mastectomy for breast cancer were randomized into two groups. Group A patients received a superficial serratus plane block with 30 mL of 0.25% bupivacaine, and group B patients received a deep serratus plane block with 30 mL of 0.25% bupivacaine. Postoperatively, the Numerical Rating Scale (NRS) score was measured during the immediate postoperative period, after 30 minutes and at one, four, eight, 16, and 24 hours, as well as on the second and third day. After discharge, the NRS scores were recorded in the second and third weeks and then monthly once for three months. All patients received patient-controlled analgesia with intravenous (IV) morphine. The duration of analgesia, pain scores, and 24-hour morphine consumption were also noted. Results In group A, the mean duration of analgesia (hours) was 5.51 ± 1.42, whereas in group B the mean duration of analgesia (hours) was 6.69 ± 1.18 (p < 0.01). NRS scores for pain during rest at 12 and 16 hours and NRS scores for pain during cough at eight, 12, and 16 hours, as well as at the third month were significantly lower in group B. However, morphine consumption was comparable between the groups. Conclusions Deep serratus plane block was associated with better NRS scores for pain on rest and coughing and prolonged duration of analgesia after a modified radical mastectomy. We conclude that the deep serratus plane block provides superior and extended analgesia than the superficial serratus plane block after a modified radical mastectomy.

Analgesic Efficacy of Intravenous Dexamethasone as an Adjunct to Ultrasound-Guided Paravertebral Block with Bupivacaine in Video-Assisted Thoracoscopic Surgery.

PurposeThoracic paravertebral block (TPVB) is a recommended regional analgesia during video-assisted thoracoscopic surgery (VATS). However, single-injection TPVB does not last long enough to provide sufficient acute postoperative pain relief. Continuous TPVB through a catheter is technically challenging and often unreliable. Intravenous dexamethasone extends the analgesic duration with some peripheral nerve blocks. However, data on the effect of intravenous dexamethasone on pain relief with TPVB are limited. This study aimed to assess the analgesic efficacy of intravenous dexamethasone in patients who received TPVB for VATS.Patients and MethodsIn this multicenter prospective randomized controlled trial, we recruited patients aged between 18 and 80 years with the American Society of Anesthesiologists of physical status class 1–3 and underwent elective VATS. Patients under general anesthesia randomly received 8 mg of intravenous dexamethasone (group D) or normal saline (group C). Ultrasound-guided TPVB (USG-TPVB) was performed at the T4–T5 and T6-T7 spaces. Multimodal analgesia was achieved via paracetamol, tramadol and intravenous morphine for both study groups. The primary outcome was time for the first analgesic requirement. Postoperative pain in terms of numeric rating score (NRS), total morphine consumption and postoperative nausea and vomiting (PONV) were assessed.ResultsAfter excluding one patient, 59 patients were analyzed. There were no intergroup differences in baseline characteristics. The time to first analgesic requirement was longer in group D (305 [240, 510] minutes) than in group C (270 [180, 300] minutes) (P value = 0.02). The NRS at rest and on movement was lower in group D than in group C at 12 hours but did not differ at other time points. Postoperative morphine consumption was significantly lower in group D than in group C at 6,12,24 and 48 hours. Incidences of PONV were comparable between the groups.ConclusionIntravenous dexamethasone, used as an adjunct to a single-injection USG-TPVB prolonged analgesic duration, had an opioid-sparing effect and provided better postoperative pain relief after VATS.

Comparison between low-dose intravenous and caudal dexamethasone as adjuvants to caudal bupivacaine in children undergoing lower abdominal surgeries

Background Caudal block is the most common regional anesthetic technique performed for analgesia for pediatric surgeries. The aim of this study was to evaluate dexamethasone through intravenous and caudal routes as adjuvants to caudal block for postoperative analgesia for pediatric patients who underwent lower abdominal surgeries. Patients and methods This prospective, randomized, double-blinded controlled study included 150 children who were divided into three equal groups. All patients received caudal analgesia with 0.125% hyperbaric bupivacaine 1 ml/kg. Group C received an intravenous injection of 10 ml normal saline, group D received 0.1 mg/kg dexamethasone added to the caudal analgesia, and 10 ml normal saline intravenous, while group IV received dexamethasone 0.1 mg/kg in 10 ml normal saline intravenous. The primary outcomes were the duration and severity of postoperative pain. The amount of rescue analgesic doses, residual motor block, and side effects such as nausea, vomiting, and hyperglycemia (secondary outcomes) were monitored. Results Dexamethasone groups (D, IV) showed a significantly prolonged duration of postoperative analgesia in comparison to the control group (C) and group D showed a longer duration of analgesia and delayed analgesic rescue when compared with the dexamethasone IV group. CHIPPS was the least in group D compared with group C and group IV at 3, 6, 12, and 24 h. Postoperative nausea and vomiting were significantly lower in group IV compared with the other two groups. Conclusions Dexamethasone either caudal or low-dose intravenous was effective for prolonging the duration of analgesia from caudal blockade with bupivacaine, while caudal dexamethasone was more effective. Intravenous dexamethasone had the upper hand in decreasing postoperative nausea and vomiting.

Randomized Comparative Study Between Bilateral Erector Spinae Plane Block and Transversus Abdominis Plane Block Under Ultrasound Guidance for Postoperative Analgesia After Total Abdominal Hysterectomy.

Introduction: Ultrasound-guided erector spinae plane (ESP) block has emerged as an effective and safe analgesic regional technique and it also provides visceral pain relief. Our aim was to compare the analgesic efficacy of ESP block over transversus abdominis plane (TAP) block under ultrasound guidance following a total abdominal hysterectomy.Methods: This was a prospective, randomized, comparative study. Thirty females posted for elective open total abdominal hysterectomy under general anesthesia were randomly allocated into two groups. Ultrasound-guided ESP block was applied in group E at the T-9 level bilaterally. The study solution was prepared by mixing 20 ml of 0.5% bupivacaine plus 10 ml of 2% lignocaine and 1 ml (50mcg) of fentanyl and 9 ml of normal saline forming total 40 ml of which 20 ml was injected on each side. Group T received ultrasound-guided TAP block with 20 ml of study solution bilaterally. The study solution was prepared similarly by mixing 20 ml of 0.5% bupivacaine plus 10 ml of 2% lignocaine and 1 ml (50mcg) of fentanyl and 9 ml of normal saline (total 40 ml) of which 20 ml was injected into each side. Tramadol 100mg iv was given as rescue analgesia whenever NRS ≥ 4 or on-demand in the postoperative period. The primary outcome was changes in a numerical rating scale (NRS) pain score postoperatively between two groups in 24 h, duration of analgesia and total rescue analgesic required during 24 h. The secondary outcome was patient satisfaction level and side effects if any.Results: Demographic data were comparable in both groups. The NRS pain score was significantly lower ​​​​in group E than in group T at second, third, fourth, fifth (p < 0.001) and at sixth hour (p < 0.05) postoperatively. The mean duration of analgesia was significantly more in Group E (4.73±0.7 h) compared to group T (2.60±0.51 h) (p < 0.001). The tramadol consumption was seen significantly more in 24 h in group T (233.33±25.82 mg) than in group E (193.33±17.59 mg). Patient satisfaction score was significantly higher at 12 h with mean value of 6.07±0.26 in group E compared to 3.40±0.91 in group T.Conclusion: We conclude that ultrasound-guided ESP block provide better postoperative pain control and prolonged duration of analgesia with less tramadol consumption compared to ultrasound-guided TAP block in patients after total abdominal hysterectomy.

Comparative evaluation of efficacy of two doses of dexmedetomidine as adjuvant to ropivacaine ultrasound guided supraclavicular brachial plexus block

&lt;p class="abstract"&gt;&lt;strong&gt;Background: &lt;/strong&gt;Dexmedetomidine as neuraxial adjuvant decreased postoperative pain intensity, prolonged analgesic duration. But use of dexmedetomidine is associated with doses dependent increase in adverse effect like hypertension, hypotension, bradycardia, excessive sedation, sleepiness. Optimal dose of dexmedetomidine is still uncertain. Present study has been designed with an aim to evaluation of efficacy of two doses of dexmedetomidine as adjuvant to ropivacaine ultrasound guided supraclavicular brachial plexus block.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The patients were randomly divided in to two groups. Group A were received 15 ml of 0.5% ropivacaine with 50 µg one ml dexmedetomidine. Group B were received 15 ml of 0.5% of ropivacaine with 100 µg of dexmedetomidine. Parameters observed were onset of motor block, onset of sensory block, duration of sensory block, duration of motor block. Adverse drug reaction like hypertension, hypotension, bradycardia and sedation were recorded.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results: &lt;/strong&gt;We have observed that mean duration of analgesia was longer in group B than group A (650.54±98.54 min versus 702.22±80.24 min) but the difference is not significant statistically (p=0.08). Time for requirement of rescue analgesia was longer in group B than group A (713.45±96.21 min versus 789.23±99.23 min) but the difference is significant statistically (p=0.04).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; From present study we can conclude that 100 µg dexmedetomidine as adjuvant to ropivacaine is no significantly better that reducing time of onset of sensory and motor block and prolongation of motor and sensory block. Duration of analgesia was comparable in both doses but time required for rescue analgesia was significantly longer higher dose group.&lt;/p&gt;

A study to compare the efficacy of intrathecal dexmedetomidine versus nalbuphine as an adjuvant to 0.5% hyperbaric bupivacaine for postoperative analgesia in lower abdominal surgeries

BackgroundThe subarachnoid block is a commonly used technique for lower abdominal surgeries. Bupivacaine being a cost-effective drug gives satisfactory analgesia for 90–120 min. Adjuvants such as dexmedetomidine and nalbuphine extend the analgesia in the postoperative period. In this study, we aimed to compare the effects of intrathecal dexmedetomidine and nalbuphine as an adjuvant to hyperbaric bupivacaine regarding the duration of analgesia as the primary objective and the time of onset of sensory and motor blockade, duration of motor blockade, haemodynamics parameters like mean heart rate and mean arterial blood pressure, and side effects if any being the secondary objectives. Eighty patients, aged 18–65 years of ASA physical status I and II, were randomly allocated into two groups. Group NB (n = 40) received 0.5% Inj. hyperbaric bupivacaine 18 mg (3.6 ml) + Inj.nalbuphine 1.0 mg (0.1 ml) while group DB (n = 40) received 0.5% Inj. hyperbaric bupivacaine 18 mg (3.6 ml) + Inj.dexmedetomidine 10 μg (0.1 ml).ResultsPatients in group DB had a significantly prolonged duration of analgesia as compared to group NB. The early onset of sensory and motor blockade was noted in group DB(P < 0.05). The duration of motor blockade was significantly prolonged in group DB (P < 0.05). Patients in both groups showed no significant difference in haemodynamic changes and incidence of side effects (P > 0.05).ConclusionsDexmedetomidine as an intrathecal adjuvant was found to have prolonged sensory and motor block and provide good quality of postoperative analgesia and stable haemodynamics with minimal side effects as compared to nalbuphine.

COMPARATIVE STUDY OF ROPIVACAINE ALONE VERSUS ROPIVACAINE WITH DEXAMETHASONE AS AN ADJUVANT IN SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK

Brachial plexus block provide a useful alternative to general anaesthesia for upper limb surgeries.Ropivacaine is one of the most frequently used local anaesthetic which has longer duration of action but has drawbacks of delayed onset and patchy analgesia. Dexamethasone is very potent glucocorticoid with very good anti-inflammatory and analgesic activity. A prospective, randomised double blinded study was undertaken in patients posted for upper limb surgeries under supraclavicular block. 80 patients with ASA class I and II were randomly grouped into two groups. Group R received 28ml ropivacaine 0.5% and 2ml normal saline and Group RD received combination of 28ml ropivacaine 0.5% and 2ml/8mg dexamethasone. 30ml solution is used for a single shot blockade of supraclavicular brachial plexus. Combination of ropivacaine 0.5% and dexamethasone 8mg has significantly hasten onset and duration of sensory and motor blockade and prolonged duration of analgesia.

13: Effects of buprenorphine and dexmedetomidine as adjuvants to low dose 0.5% heavy bupivacaine in spinal anaesthesia in patients undergoing transurethral resection of prostate – A comparative study.

<bold>Background and Aim:</bold>Benign prostatic hypertrophy is common in elderly men. Spinal anaesthesia is preferred in transurethral resection of prostate (TURP). This study compares sensory, motor effects and haemodynamics of buprenorphine and dexmedetomidine as adjuvants to low dose 0.5% heavy bupivacine in spinal anaesthesia .Methods:fter Institutional Ethics Committee approval, a comparative study was conducted which included 30 elderly male patients in the age group 55-75 years belonging to American Society of Anesthesiologists (ASA) grades I and II physical status scheduled for TURP. Patients were randomised into two groups using computer generated random numbers. Group B (n-15) received 2ml 0.5% heavy bupivacine with 45µg buprenorphine and Group D(n-15) received 2ml 0.5% heavy bupivacine with 5µg dexmedetomidine intrathecally.Intra-operatively,following parameters were recorded: Time of onset of T10 , Highest level of motor block sensory analgesia , Time to regression of motor block to Bromage 0 , Duration of analgesia and haemodynamics .Results:A total of 30 patients were included in the study. The demographic data was comparable between the groups .The duration of analgesia in Group-B was 297±43.3 min and in Group-D 412±74.7 min with P value 0.002). There was low incidence of any perioperative complication such as hypotension, bradycardia,nausea and vomiting.Conclusion:Addition of buprenorphine 45µg or dexmedetomidine 5µg to 0.5% heavy bupivacaine intrathecally in TURP resulted in prolonged duration of analgesia with haemodynamic stability. Dexmedetomidine has prolonged duration of analgesia with significant p value (0.002).Variables (min)Group B (mean±SD)Group D (mean±SD)Onset of T10 block6±2.325.7±3.19Highest sensory levelT6T8Regression of motor blockade to Bromage 0223±25.5333±83.99Duration of Analgesia297±43.3412±74.7

A Comparative Study of Intrathecal Magnesium Sulphate with or without Intrathecal Fentanyl to 0.5% Hyperbaric Bupivacaine in Parturients Undergoing Elective Lower Segment Caesarean Section

Background: Prolongation of analgesia in Neuraxial anaesthesia is achieved by adding various adjuvants intrathecally along with local anaesthetic agent. Using two adjuvants together in lower doses will prolong the duration of analgesia without causing much side effects. Aims: To compare the efficacy and safety of Intrathecal Magnesium v/s Fentanyl with Magnesium sulphate as an adjuvant to 0.5% Bupivacaine in terms of onset and duration of Sensory and Motor Blockade and Duration of Postoperative analgesia. Material and Methods: Prospective randomized double blinded study was conducted on 70 ASA 1 &amp; 2 patients undergoing elective caesarean section. They were randomly divided into two groups (35 each). All patients received spinal anaesthesia. Group M received 1.7 ml of 0.5% bupivacaine, 0.1 ml (50 mg) magnesium sulphate and 0.2 ml of normal saline intrathecally. Group FM received 1.7 ml of 0.5% bupivacaine, 0.1 ml (50 mg) magnesium sulphate and 0.2 ml (10microgram) of fentanyl intrathecally. Results: Onset of sensory block was similar in Group M and Group FM. Duration of sensory block was prolonged in group FM (191±45.60) compared to Group M (178.12±38.06). Duration of analgesia was significantly prolonged. Conclusion: We conclude that, the addition of both intrathecal magnesium sulphate and fentanyl to bupivacaine for spinal anesthesia, in parturients undergoing elective LSCS results in prolonged duration of analgesia.

Comparative study of bupivacaine-lignocaine to bupivacaine-lignocaine-dexamethasone in providing postoperative analgesia in interscalene block for shoulder arthroscopy

Interscalene brachial plexus block has gained prominence nowadays and has benefits of lesser intraoperative anaesthetic use, lesser analgesic requirement and lesser incidence of postoperative nausea and vomiting. Adjuvants are added to local anaesthetics for prolonging postoperative analgesia with interscalene block. Among the adjuvants, dexamethasone has been used extensively in past decade in neuraxial and peripheral nerve blocks. The aim of the study was to compare the duration of postoperative analgesia with lignocaine- bupivacaine combination and dexamethasone added to lignocaine - bupivacaine in interscalene block for shoulder arthroscopy. In this comparative study, 48 patients of ASA grade I and II were selected and divided into 2 groups of 24 each. After obtaining informed written consent, general anaesthesia was given to patients satisfying inclusion criteria and ultrasound guided interscalene block was performed. Time of demand for additional analgesic supplementation by the patient were noted. Hemodynamic and respiratory monitoring were done to assess any side effects and complications.Duration of analgesia was prolonged in group II (10.33±1.45 hours) i.e in lignocaine-bupivacaine-dexamethasone group than Group I(7.17±0.87 hours) i.e in lignocaine-bupivacaine group with p value less than 0.001. There were no significant differences between the two groups in secondary outcomesbased on hemodynamic parameters. Dexamethasone at a dose of 8 mg in addition to lignocaine-bupivacaine, given perineurally in interscalene block provided better quality of block and prolonged duration of analgesia by almost 3 hours, without any significant changes in hemodynamic parameters. There were no major adverse effects noted.

A prospective comparative randomized controlled study of erector spinae plane block using local anesthetics versus general anesthesia for the perioperative control of pain in patients undergoing thoracoscopic procedures

Background: Patients posted for video-assisted thoracoscopic surgeries (VATS) are nowadays managed intraoperatively by general anesthesia (GA) with the use of oral and parenteral analgesics in the post-operative period. Ongoing research points out that the erector spinae plane block (ESP Block) with local anesthetics is a safe technique for the perioperative management of pain in thoracoscopic procedures. Aims and Objectives: Our study aimed at comparing ultrasound guided ESP block using local anesthetics versus GA for perioperative pain management in patients who underwent thoracoscopic procedures. The objectives of this research were to assess the hemodynamic changes in patients undergoing the procedure, to calculate the total amount of analgesics required by patients in the next 24 h, to assess the overall patient satisfaction and complications in the post-operative period. Materials and Methods: In this prospective comparative randomized controlled trial, 40 patients aged 18–65 years planned to undergo VATS were enrolled and randomized to either group G or group E in equal numbers depending on the anesthetic technique employed. Group G patients received GA and Group E patients received ultrasound guided ESP block. Both the groups were compared for hemodynamic stability, pain in postoperative period using visual analog scale (VAS), time to first rescue analgesia requested since induction, total amount of rescue analgesia requested, overall patient satisfaction, and post-operative complications. Results: Better control of hemodynamic parameters, less post-operative pain, prolonged duration of analgesia (P &lt; 0.05), and requirement of lesser amount of rescue analgesics were observed in patients of Group E in comparison with patients of Group G. Side effects such as post-operative nausea and vomiting were more in patients of Group G in the first 24 h (P &lt; 0.05). Conclusion: ESP block with local anesthetics can be used as an effective sole anesthetic technique for VATS &lt;60 min providing a longer pain free post-operative period, lesser rescue analgesic requirement, better patient satisfaction, and lesser post-operative complications.

A comparative study with 15 ml of 0.25 % bupivacaine between USG guided paravertebral block and peritubal infiltration for post-operative analgesia in patients undergoing percutaneous nephrolithotomy

OBJECTIVE: To compare with 15 ml of 0.25 % bupivacaine between USG guided paravertebral block and peritubal infiltration for post-operative analgesia in patients undergoing percutaneous nephrolithotomy MATERIALS AND METHODS: It is a prospective, randomized double blind study. 60 patients posted for PCNL surgeries were randomly allocated into two equal groups of 30 each. • Group P(30) received thoracic paravertebral block (T9-T10, T10-T11, T11-T12) with 15 ml of 0.25% Bupivacaine. (3ml at each level). • Group T(30) received peritubal infiltration with 15 ml of 0.25% Bupivacaine. RESULTS: Age, ASA grading, and duration of surgery, calculi position and size, access tract and success rate were comparable between the two groups. Paravertebral block provided better postoperative analgesia than peritubal infiltration in terms of duration and requirement of first rescue analgesia. CONCLUSION: Paravertebral block provided prolonged duration of analgesia for PCNL surgeries when compared to peritubal infiltration Keywords: Paravertebral block, Peritubal infiltration , Bupivacaine, post-operative analgesia.

Comparison of intrathecal bupivacaine-fentanyl and bupivacaine-butorphanol combinations for joint replacement surgeries.

Background and Aims:The objective of the study was to compare duration of analgesia of fentanyl versus butorphanol as adjuvants to bupivacaine in spinal anesthesia.Material and Methods:A prospective, randomized, double-blinded study conducted in 80 patients of 18–75 years age group and American Society of Anesthesiologists Grades I and II undergoing joint replacement surgeries. A total of 40 patients in each Group A and Group B received 0.5% bupivacaine 3 ml with 25 mcg fentanyl and 25 mcg butorphanol respectively, in a total volume of 3.5 ml made with saline. Duration of analgesia, number of rescue analgesia, sensory, and motor block characteristics were compared between the two groups. Statistical analysis was done using t test and Chi-square test with SPSS 19.0 software.Results:Mean duration of analgesia was found more in Group B in comparison to Group A (P < 0.05). A number of doses of analgesic required postoperatively were more in Group A compared to Group B (P < 0.001). Time required for onset of sensory and motor block was comparable in both the groups. However, two segment regression of sensory block was slower in Group B compared to Group A (P < 0.05).Conclusion:We conclude that addition of butorphanol 25 μg as an adjuvant to 0.5% hyperbaric bupivacaine provided prolonged duration of analgesia compared to 25 mg fentanyl.

Ultrasound-guided infraclavicular brachial plexus block using bupivacaine alone or combined with dexmedetomidine for hand and forearm surgeries

Background Pain was identified by the International Association for the Study of Pain as an unpleasant sensory or emotional experience associated with actual or potential tissue damage. The incidence of inadequate pain management seems to be high, even in the developed countries. Traumatic upper limbs injuries are accountable for a considerable number of patients, who require care by medical facilities (5–10% of emergency department visits). Regional anesthesia [e.g. brachial plexus block (BPB)] is increasingly taking place in patients with upper limb injuries as it is a logical choice avoiding the side effects of muscle relaxants, narcotics, and potent volatile anesthetics used in general anesthesia. Different additives have been used as an adjuvant with local anaesthetics to achieve dense and prolonged block and adequate postoperative analgesia. Objective To evaluate the effects of adding dexmedetomidine to bupivacaine versus bupivacaine alone in infraclavicular BPB with ultrasound guidance for plastic and reconstructive surgeries of the hand and forearm as regards the duration of postoperative analgesia, onset, and the duration of sensory and motor block and postoperative analgesic requirements. Patients and methods This randomized double-blind study carried out in Alexandria Main University Hospital on 70 adult patients of both sexes aged from 20 to 40 years, who were evaluated as American Society of Anesthesiologists I or II physical status and were scheduled for plastic and reconstructive surgeries of the hand and forearm. Results The results of our study show that the duration of analgesia ranged from 450 to 690 min with a mean value of 588.90±73.15 min in group C ‘control,’ while the duration of analgesia ranged from 990 to 1440 min with a mean value of 1295.10±121.60 min in group D ‘dexmedetomidine.’ Comparing the two groups, there was significant statistical difference in the duration of analgesia between the two groups, showing prolonged duration of analgesia in group D more than in group C. Conclusion Administration of bupivacaine with dexmedetomidine in infraclavicular BPB provides prolonged postoperative analgesia without causing a significant hemodynamic instability. Also, coadministration of dexmedetomidine leads to significantly decreased total analgesic doses required postoperatively with minimal side effects.

Alpha2 -receptor agonists as adjuvants for brachial plexus nerve blocks-A systematic review with meta-analyses.

We review the efficacy and safety of dexmedetomidine and clonidine as perineural or systemic adjuvants for brachial plexus blocks (BPB). We included randomised controlled trials on upper limb surgery with BPBs in adults, comparing dexmedetomidine with clonidine or either drug with placebo. The primary outcome was duration of analgesia. Secondary outcomes included adverse and serious adverse events. The review was conducted using Cochrane standards, trial sequential analyses (TSA) and Grading of Recommendations Assessment, Development and Evaluation (GRADE). We included 101 trials with 6248 patients. Overall, duration of analgesia was prolonged with both clonidine (176min [TSA adj. 95% CI: 118, 205, p<.00001; 33 trials]) and dexmedetomidine (292min [TSA adj. 95% CI: 245329, p<.00001; 53 trials]), but was longer for dexmedetomidine than clonidine (205min [TSA adj. 95% CI: 157, 254, p<.00001; 19 trials]). Compared with placebo, dexmedetomidine was associated with bradycardia (RR 4.2 [95% CI 2.2, 8.3]), and both clonidine (RR 4.5 [95% CI 1.1, 18.3]) and dexmedetomidine (RR 3.9 [95% CI 2.0, 7.5]) were associated with hypotension. Serious adverse events were mostly related to block technique. GRADE-rated quality of evidence was low or very low. Alpha2-receptor agonists used as adjuvants for BPBs lead to a prolonged duration of analgesia, with dexmedetomidine as the most efficient. Alpha2-receptor agonists were associated with increased risk of cardiovascular adverse events. The quality of evidence was low to very low.

Comparison of nalbuphine versus fentanyl as intrathecal adjuvant to bupivacaine for orthopedic surgeries: A randomized controlled double-blind trial.

Background and Aims:Intrathecal adjuvants are used with local anesthetics to prolong the duration and provide postoperative pain relief while minimizing the dose of local anesthetic. Nalbuphine is an agonist-antagonist opioid and provides prolonged duration of analgesia with fewer side effects of fentanyl such as pruritus, nausea, and vomiting. The aim of this study was to evaluate and compare the onset and duration of sensory and motor blockade, hemodynamic effects, duration of postoperative analgesia, and adverse effects of nalbuphine and fentanyl given intrathecally with hyperbaric 0.5% bupivacaine in orthopedic lower limb surgeries.Material and Methods:Sixty six patients classified in American Society of Anesthesiology (ASA) classes I and II scheduled for orthopedic lower limb surgeries were enrolled. Patients were randomly allocated to receive 15 mg of hyperbaric bupivacaine with either 1 mg nalbuphine (group N), 25 μg fentanyl (group F) or 0.9% normal saline (group C) intrathecally.Results:Patients who received intrathecal nalbuphine (group N) had a significantly delayed onset of sensory and motor block as compared to patients who received fentanyl (group F). The time to two segment regression was significantly prolonged in group F (122.05 ± 10.65 minutes) as compared to group N (114.55 ± 10.90 minutes) [P < 0.05]. The mean duration of motor blockade was significantly prolonged in group F (197.73 ± 15.09 minutes) as compared to group N (180.68 ± 15.68 minutes) [P < 0.05]. Duration of spinal analgesia was comparable in group N (323.18 ± 57.39 minutes) and group F (287.05 ± 78.87 minutes), both significantly more than group C (224.32 ± 42.54 minutes). Hemodynamic effects, 24-h rescue analgesic requirements, and incidence of side effects were comparable among group N and F.Conclusion:Intrathecal nalbuphine in a dose of 1 mg is an equally useful alternative to fentanyl in a dose 25 μg when used as an intrathecal adjuvant to bupivacaine for lower limb surgeries. The prolonged duration of analgesia and no adverse effects makes it a good choice for the orthopedic procedures of lower limb.

English

BACKGROUND Isobaric levobupivacaine has minimal effect on positional variation of sensory and motor blockade given intrathecally. Also, it has lesser cardiotoxic and neurotoxic effects. Present study was done to compare efficacy, analgesia haemodynamic effects and any adverse effects after spinal anaesthesia with isobaric levobupivacaine with nalbuphine and fentanyl as adjuvants in transurethral endoscopic surgeries. METHODS 60 male adult patients of American Society of Anaesthesiologists (ASA class I-III) of age group 40 - 80 years were randomized into 2 groups (n = 30) in this prospective, double blinded study. 10 mg of 0.5 % levobupivacaine with 25 µg fentanyl in group LF and 10 mg of 0.5 % levobupivacaine with 0.8 mg nalbuphine in group LN. Parameters assessed were sensory and motor blockade characteristics and hemodynamic variables in both the groups. Adverse effects were recorded if any. RESULTS Onset of sensory and motor blockade were significantly faster in group LF compared to group LN. In both the groups, time for two segment regression was comparable. Statistically significant prolonged analgesic duration was noticed in group with nalbuphine than fentanyl as adjuvant to isobaric levobupivacaine. Difference in haemodynamic variation was not significant in both the groups. CONCLUSIONS Intrathecal nalbuphine 0.8 mg as an adjuvant with isobaric levobupivacaine 0.5 % 10 mg is as efficacious as fentanyl 25µg in transurethral endoscopic surgeries in elderly population with better hemodynamic stability. KEY WORDS Levobupivacaine; Fentanyl; Nalbuphine; Spinal anaesthesia.

Effectiveness of Pre-Operative Subcutaneous Infiltration of Ketamine for Post-Operative Analgesia and Haemodynamic Attenuation

Background: Ketamine is a noncompetitive antagonist of N-methyl-D-aspartate (NMDA) receptor which plays an important role in pain modulation. It decreases acute postoperative pain by inhibiting C fiber activity.&#x0D; Objective: Purpose of this study was to evaluate the effectiveness of preoperative subcutaneous infiltration of ketamine for postoperative analgesia and haemodynamic attenuation.&#x0D; Materials and Methods: This Randomized controlled trial study was conducted among the patients with ASA (Ameracin Society of Anaesthesiologist) grade I &amp; II, planned for major abdominal surgery with upper midline incision. Total 60 patients were selected and allocated into two groups, 30 in each- group A &amp; B. Group A - Patients received subcuteneous wound infiltration with ketamine. Group B - Patients given subcuteneous wound infiltration with bupivacaine. Then haemodynamic status and patient outcome was assessed at different point of time.&#x0D; Results: There was no significant difference between groups in respect of demographic and ASA status. Mean age was found to 38.7±8.53 years. In Group A, 63.3% were ASA I and 36.7% were ASA II. In Group B, 60% were ASA I and 40% were ASA II. It has become evident that satisfactory analgesia can be acheived by subcuteneous wound infiltration with ketamine (in Group-A).The Mean verbal pain score was 5.2±0.47 and 7.4±0.68 in group A &amp; group B respectively. The difference was statistically significant (p&lt;0.05). After 2hrs, mean sedation was found 4.38±0.57 score in group A, but in group B score is reduced and found 3.52±0.27. Mean difference was statistically significant (p&lt;0.05) between two groups.&#x0D; Conclusion: Surgical site infiltration of ketamine is a promising analgesic method in reduction of postoperative pain with minimal sedation and adverse effects. There was significantly prolonged duration of analgesia and better outcome.&#x0D; KYAMC Journal.2021;12(1): 26-31