Segment Regression Time Research Articles

Effect of dexmedetomidine infusion on characteristics of spinal anesthesia with hyperbaric bupivacaine: A randomized controlled trial

Dexmedetomidine is a highly selective and potent α2 agonist having both sedative and analgesic properties. This study was aimed to assess the effects of intravenous dexmedetomidine on sensory, motor, haemodynamic parameters and sedation during subarachnoid block (SAB) with 0.5% hyperbaric bupivacaine. Sixty patients undergoing infraumbilical and lower limb surgeries were allocated into 2 groups, group D (n=30) received dexmedetomidine infusion at the rate of 0.5 µg/kg/h over an hour prior to SAB and continued till the end of surgery whereas patients in group C (n=30) received similar volume of normal saline infusion for the same duration. Onset of sensory block was 63.77 ± 7.42 s in group D compared with 126.2 ± 12.83s in group C. Two segment regression time was 177.03 ± 11.64 min in group D and 85.67 ± 10.32 min in group C and analgesia duration was 287.67 ± 14.84 min in group D and 149 ± 13.16 min in group C. Onset of motor block was 3.95 ± 0.65 min in group D and 4.5 ± 0.62 min in group C. Motor blockade duration was prolonged in group D compared with group C. There was significant difference between the groups in respect to block characteristics. Administration of intravenous dexmedetomidine during SAB hastens the onset and prolongs the duration of sensory and motor block. It also provides conscious sedation and additional analgesia.

Comparison of Two Different Volumes of Epidural Normal Saline for Enhancing the Effects of Spinal Anesthesia in Adult Patients Undergoing Elective Lower Limb Surgeries: A Prospective Randomized Study

Background: The combined spinal-epidural (CSE) anesthesia technique gives a reliable subarachnoid block as well as the flexible epidural block. One of the modified technique of CSE is epidural volume expansion (EVE) in which normal saline or local anesthetic (LA) is instilled though epidural catheter leading to increase in level of sensory blockade. Aim of the study was to compare two different volumes of normal saline for enhancing the effects of spinal anaesthesia in adult patients undergoing elective lower limb surgeries.
 Methods: 90 patients were randomly divided into two group. Group A - 45 patients who were received intrathecal 2.0ml of 0.5% hyperbaric bupivacaine and epidural 10ml of 0.9% normal saline for EVE using CSE technique. Group B - 45 patients who were received intrathecal 2.0ml of 0.5% hyperbaric bupivacaine and epidural 15ml of 0.9% normal saline for EVE using CSE technique.
 Results: The demographic data were comparable in both groups. Significant difference was seen in total duration of sensory blockade between group A (192.11±9.80) and group B (Mean ± SD 215.33±17.57minutes) (p<0.0001). Total duration of motor blockade was longer in group B (Mean± SD: 181.91± 16.42) as compared to group A (Mean ± SD: 162.48 ± 9.35 minutes) (p<0.0001).
 Conclusion: We conclude that epidural volume expansion (EVE) with 15 ml epidural normal saline was associated with faster onset, higher level and early achieve maximum level of sensory blockade, longer two segment regression time, early onset and longer duration of motor blockade as compared to EVE with 10 ml epidural normal saline.

Comparative Analysis of Efficacy & Post-Operative Analgesia with Hyperbaric Bupivacaine and Nalbuphine Combination Versus Hyperbaric Bupivacaine and Fentanyl Combination in Infraumbilical Surgeries

Spinal anaesthesia is one of the most commonly used technique for lower abdominal and lower limbs surgeries. However its short duration of action and early arising post-operative pain moves the focus towards the use of adjuvant to it. So numbers of adjuvant from different groups were used and evaluated. Out of which opioids are the most commonly used family as an intrathecal adjuvant to local anaesthetics. Our aim of the study to evaluate the analgesic efficacy of hyperbaric Bupivacaine & Nalbuphine versus hypebaric Bupivacaine & Fentanyl in infraumbilical surgeries. The study was conducted during period of 2020 to 2022 at tertiary care center. Total 100 patients were participated in study each group includes 50. Demographic data, onset of sensory & motor block, duration of sensory and motor block, two segment regression time and first rescue analgesia time were noted. The onset of sensory and motor block was earlier in Bupivacaine plus Nalbuphine (BN) combination as compared to Fentanyl plus Bupivacaine (BF) combination. Two segment regression time was longer with BN group. Nalbuphine also shows good hemodynamic stability. Rescue analgesia time with Nalbuphine was much longer than Fentanyl. The adverse effect was also much less with Nalbuphine. Nalbuphine could be a better and settle alternative to the Fentanyl and other opioids as adjuvant to intrathecal local anaesthetics.

Spinal Anaesthesia for Ambulatory Perianal Surgeries: A Comparison between Short Acting and Long Acting Local Anaesthetics

Introduction: Chloroprocaine (ester group) is a preservativefree local anaesthetic which is available as isobaric solution. It is being recently popularised in spinal anaesthesia for its shorter duration of action which plays a significant role in the early ambulation and voiding functions, which is the primary essence in ambulatory surgery. Intrathecal Bupivacaine is the most commonly used drug for its block characteristics, taking into account not only the fast initiation of sensory and motor blockade but also faster sensory and motor regression. Aim: To compare the block characteristics between 1% Chloroprocaine and 0.5% Bupivacaine in patients undergoing perianal surgeries under spinal anaesthesia. Materials and Methods: This randomised, interventional double blinded study was carried out in Chettinad Hospital and Research Institute, Kelambakkam, Chennai, Tamil Nadu, India, from April 2020 to August 2021. The patients were split into two groups of 34 each. Group-1: Patients received 30 mg of 1% Chloroprocaine intrathecally. Group-2: Patients received 10 mg of 0.5% Bupivacaine intrathecally. In both the groups the onset, duration of both sensory and motor blocks, intraoperative haemodynamic, two segment regression time, time to ambulation and micturition, the time to eligibility for discharge from hospital was evaluated. Independent sample t-test, chi-square test and Fisher’s-Exact test were employed to compare the distribution of qualitative variables between the groups. Results: Total of 68 participants 31 (45.6%) males and 37 (54.4%) females), 34 in each group 1 and group 2 were analysed. Both groups contained maximum patients in >45 years age group, 12 (35.2%) in each group. Demographic and anthropometric parameters of patients in both the groups were comparable. Mean time of ambulation after spinal anaesthesia in the Group-1 was 137.65±9.15 minutes and in Group-2 was 193.38±8.14 minutes (p-value <0.05). Mean time taken to return of voiding function the Group-1 was 157.06±16.05 minutes and in Group-2 was 213.53±10.26 minutes (p-value <0.05). Mean time taken for Post-Anaesthetic Discharge Scoring System (PADSS) score >9 in Group-1 was significantly less (165.29±13.59 minutes) than Group-2 (219.41±9.52 minutes). Mean time duration for request of first rescue analgesic in Group-1 was significantly faster (104.71±8.69 minutes) than Group-2 (157.79±8.81 minutes). There was no significant difference in haemodynamic changes between the study groups. Conclusion: Chloroprocaine has proved to be better than bupivacaine. It has proven to provide adequate surgical anaesthesia, it leads to early regression of motor and sensory blocks, faster un-assisted ambulation and micturition. Time to rescue analgesia was earlier in the Group-1 when compared to Group-2.

Effect of Low Dose Intravenous Magnesium Sulphate on Sensory Regression Time in Patients undergoing Spinal Anaesthesia- A Randomised Placebo-controlled Double-blinded Study

Introduction: Adjuvants like intravenous (i.v.) Magnesium Sulphate (MgSO4 ) are used to improve the efficacy and duration of spinal anaesthesia and postoperative analgesia. But it is unclear, whether this prolongation of duration of analgesia is an independent effect of MgSO4 or it is because of increased duration of spinal anaesthesia itself. Aim: To evaluate the effect of intraoperative i.v. low dose MgSO4 on two-segment regression time of sensory block, regression time up to L2 dermatome from the highest level of sensory block and postoperative analgesic requirement. Materials and Methods: This randomised placebo-controlled blinded study was conducted in the Department of Anaesthesia, Fakhruddin Ali Ahmed Medical College and Hospital, Barpeta, Assam, India from September 2020 to August 2021. A total of 60 patients, satisfying American Society of Anaesthesiology (ASA) physical status I and status II, aged between 40-70 years, patients undergoing femur fracture surgery under spinal anaesthesia were enrolled in the present study. Patients in the magnesium group (Group M, n=30) received MgSO4 5 mg/kg infusion, and control group (Group C, n=30) received at the same volume of saline during operation. Unpaired t-test was used to test the significance in normally distributed continuous variable and Mann-Whitney U test was used to test the significance of the difference between the quantitative variables. The software Predictive Analytics Software (PASW) 18.0 was used for statistical analysis and the graphs have been generated using the Microsoft Excel 2007. A p-value of less than 0.05 has been considered to be significant. Results: There were no significant differences between the two groups with respect to patient characteristics (age, weight, and height).The mean time for two segment regression in the group M was prolonged by around 13 minutes, as compared to group C (104.96±11.37 minutes versus 91.2±11.86 minutes, respectively, p<0.001). The mean regression time up to L2 dermatome in the group M was prolonged by 15 minutes as compared to the group C. (171.23 minutes versus 156.43 minutes, respectively, p=0.0003). The total consumption of tramadol in the group M was significantly lesser than the control group (192.5±58.03 mg and 245.0±43.74 mg, respectively, p=0.0002). Conclusion: An i.v. infusion of 5 mg/kg MgSO4 prolongs two segment regression time upto L2 dermatome and reduces postoperative opioid consumption without any complication in patients undergoing femur fracture surgery under spinal anaesthesia

Efficacy of dexmedetomidine and magnesium sulphate as adjuvant to bupivacaine among patients undergoing lower extremity surgeries

In this prospective randomised double blind study, an attempt was made to compare the effects of adding dexmedetomidine 10 mcg or magnesium sulphate 50mg to 0.5% hyperbaric bupivacaine on subarachnoid block characteristics and postoperative analgesia in patients undergoing elective lower extremity surgeries. Randomization of the participants was done in three equal groups (n=30). A total of 90 patients of age between 18-60 years of either sex and good physical status posted for elective lower extremity surgery were included. Group B received 15 mg hyperbaric bupivacaine(3ml) with 0.5ml preservative free normal saline,Group D received 15 mg hyperbaric bupivacaine (3ml) with 10 mcg dexmedetomidine in 0.5 ml preservative free normal saline intrathecally and Group M received 15 mg hyperbaric bupivacaine (3ml) with 50mg magnesium sulphate (0.5ml) intrathecally for subarachnoid block. Different parameters of sensory block, motor block and analgesia effect were assessed as outcomes. Results showed that the groups were similar in demographic parameters like age, sex, height, weight, physical status. Bupivacaine with dexmedetomidine as adjuvant shows early onset of sensory and motor block, early onset of peak block height, prolonged sensory block, prolonged two segment regression time.

Comparison of 0.5% levobupivacaine alone and 0.5% levobupivacaine with butorphanol given intrathecally in infraumbilical surgeries.

Introduction: Spinal anaesthesia is the most common neuraxial block used in surgical setting. The main advantage is the high success rate, safety record, rapid onset, predictable duration, minimal side effect and reliable offset. Study aimed to compare Levobupivacaine and Levobupivacaine with Butorphanol in terms of onset of sensory and motor blockade, duration of sensory and motor block, two segment regression time, hemodynamic changes, time for first rescue analgesia and complications in infraumbilical surgeries. Materials and methods: 60 patients of ASA class 1 and 2 of age between 19 to 65 years were selected in the study and divided them into two groups with 30 patients each. Group A - 15 mg (3 ml) of 0.5% Levobupivacaine + 0.1 ml Normal saline. Group B- 15 mg (3 ml) of 0.5% Levobupivacaine + 100 g (0.1 ml) of Butorphanol. All groups received drug at L2-L3 intervertebral space. Result: On comparing both the groups, the duration of sensory and motor blockade was more in group B. The two-segment regression time was more isn group B and the time for the first rescue analgesia was also more in group B. Hemodynamic stability was achieved in group B with minimal change in the parameters and with fewer complications. Conclusion: we concluded that addition of injection Butorphanol with Levobupivacaine gives hemodynamic stability as compared to Levobupivacaine alone intrathecally and also provides longer duration of sensory and motor blockade and superior analgesia than intrathecal levobupivacaine alone. Keywords: spinal anesthesia, analgesia, intrathecal, Levobupivacaine, Butorphanol. Reference: 1. Casey WF. Spinal anaesthesia-A practical guide. Update Anaesth. 2000;12:1-7. 2. Foster RH, Markham A. Levobupivacaine. Drugs. 2000 Mar;59(3):551-79. 3. Attri JP, Kaur G, Kaur S, Kaur R, Mohan B, Kashyap K. Comparison of levobupivacaine and levobupivacaine with fentanyl in infraumbilical surgeries under spinal anaesthesia. Anesthesia, essays and researches. 2015 May;9(2):178. 4. Stoelting RK, Hillier SC. Pharmacology and physiology in anesthetic practice. Lippincott Williams & Wilkins; 2012 Jan 11. 5. Eledjam JJ, de la Coussaye JE, Bassoul B, Brugada J. Mechanisms of the cardiac toxicity of bupivacaine. InAnnales Francaises D'anesthesie et de Reanimation 1988 Jan 1 (Vol. 7, No. 3, pp. 204-210). 6. Bardsley H, Gristwood R, Baker H, Watson N, Nimmo W. A comparison of the cardiovascular effects of levobupivacaine and rac‐bupivacaine following intravenous administration to healthy volunteers. British journal of clinical pharmacology. 1998 Sep;46(3):245-9 7. McLeod GA. Density of spinal anaesthetic solutions of bupivacaine, levobupivacaine, and ropivacaine with and without dextrose. British Journal of Anaesthesia. 2004 Apr 1;92(4):547-51. 8. Singh A, Gupta A, Datta PK, Pandey M. Intrathecal levobupivacaine versus bupivacaine for inguinal hernia surgery: a randomized controlled trial. Korean Journal of Anesthesiology. 2018 Jun;71(3):220. 9. Fattorini F, Ricci Z, Rocco A, Romano R, Pascarella MA, Pinto G. Levobupivacaine versus racemic bupivacaine for spinal anaesthesia in orthopaedic major surgery. Minerva Anestesiologica. 2006 Jul 1;72(7-8):637-44. 10. Şahin AS, Türker G, Bekar A, Bilgin H, Korfalı G. A comparison of spinal anesthesia characteristics following intrathecal bupivacaine or levobupivacaine in lumbar disc surgery. European Spine Journal. 2014 Mar;23(3):695-700. 11. Glaser C, Marhofer P, Zimpfer G, Heinz MT, Sitzwohl C, Kapral S, Schindler I. Levobupivacaine versus racemic bupivacaine for spinal anesthesia. Anesthesia & Analgesia. 2002 Jan 1;94(1):194-8. 12. Singh V, Gupta LK, Singh GP. Comparison among intrathecal fentanyl and butorphanol in combination with bupivacaine for lower limb surgeries. Journal of Anaesthesiology Clinical Pharmacology. 2006 Oct 1;22(4):371- 13. Singh SN, Subedi A, Prasad JN, Regmi MC. A comparative study to assess the effect of intrathecal bupivacaine with morphine or butorphanol

Comparative study between the effect of intrathecal bupivacaine versus bupivacaine dexmedetomidine combination in spinal anaeshtesia for lower abdominal surgeries

Abstract Study objectives We compared effect of intrathecal bupivacaine versus bupivacaine Design This is a prospective, randomized, double-blinded study. Setting The setting is at an operating room in Ain Shams University Hospital. Patients: 50 patients scheduled for general anesthesia were randomly allocated to the following 2 groups in equal numbers. Interventions Spinal anaesthesia will be performed in the sitting position at L3-L4 or L4-L5 level using a 25-gauge Quincke spinal needle by the most competent experts. The sensory block level will be assessed along the mid-clavicular line bilaterally. The motor block will be assessed according to Bromage scale Measurements Post operative (VAS) score and Time to first requested analgesia.(primary outcome), Systolic blood pressure, diastolic blood pressure, mean blood pressure and heart rate will be recorded every 5 minutes for 20 minutes then every 15 minutes till the end of surgery, Nausea and/ or vomiting as yes/no, Level of highest sensory block, Bromage score ≥3, Onset of sensory block and Two segment regression time (secondary outcomes) were recorded.. Main results Results of this study showed that the addition of dexmedetomidine to bupivacaine in spinal anaesthesia significantly prolonged both sensory and motor blockades duration compared with bupivacaine alone. They also prolonged the time of postoperative analgesia as evidenced by significantly longer time to first rescue analgesia and lower NRS scores with minimal adverse effects and haemodynamic stability. Conclusions We concluded that intrathecal dexmedetomidine increases the duration of analgesia and reduces postoperative pain without changes in the hemodynamic parameters and adverse side effects. It can be considered as an appropriate adjuvant to intrathecal local anesthetics for lower abdominal surgeries.

Comparing Duration of Analgesia after Intrathecal Administration of Opioids in Primary Paturients for Lower Segment Cesarean Section.

Background:A pain free post operative period is a boon to mother for caring the neonate. We compared injection butorphanol and fentanyl as an adjuvant to bupivacaine in primary parturients for LSCS (Lower Segment Caesarean Section) with respect to duration of analgesia.Aims and Objectives:To study the effect of butorphanol vs fentanyl on duration of analgesia when added to bupivacaine for LSCS amongst primi parturients and to observe the block characteristics as secondary outcome.Materials and Methods::Study was carried out in 90 patients divided equally into three groups which included 12mg(2 mL) of 0.5% hyperbaric bupivacaine with 0.5 mL NS, 12mg (2 mL) of 0.5% hyperbaric bupivacaine 25 μg butorphanol made upto 2.5 mL with NS and 12mg(2 mL) of 0.5% hyperbaric bupivacaine with 25μg fentanyl made upto 2.5mL with normal saline. All patients were observed for duration of analgesia. Also Heart Rate (HR), Systolic and Diastolic Blood Pressure (SBP, DBP), two segment regression time of sensory block, motor block were assessed. The results were compiled and statistically analyzed using Chi-square test for nonparametric data and ANOVA for parametric data.Results:Two segment sensory regression is significantly prolonged in group with intrathecal administration of Bupivacaine with Butorphanol (190.33±15.86) than Bupivacaine with Fentanyl (170.67±20.83) and Bupivacaine with Normal saline (150.33±16.91). Duration of effective post operative analgesia was 349.67, 591.87 and 468.00 min in Group I, Group II and Group III respectively. There was no significant difference in onset of sensory and motor blockage in all three groups. HR, SBP and DBP were comparable among the groups.Conclusions:Intrathecal bupivacaine with 25 μg butorphanol mixture was clinically better as it provided longer duration of analgesia along with prolonged sensory block when compared to intrathecal bupivacaine with 25μg fentanyl mixture in primary parturients for LSCS.

Comparison of Analgesic Efficacy of Levobupivacaine and Levobupivacaine with Nalbuphine in Inguinal Hernia Surgeries Under Subarachnoid Block

Background: Recently there has been an interest to explore the efficacy of nalbuphine as' an adjuvant to local anaesthetic agents. This study was designed to compare its analgesic efficacy when added to levobupivacaine in patients undergoing inguinal hernia surgeries under subarachnoid block. Methods: Fifty patients belonging to ASA I/II, between 18-65 years of age undergoing inguinal hernia repair were randomly allocated to receive subarachnoid block with either 12.5 mg of 0.5% isobaric levobupivacaine (2.5 ml)+ normal saline (0.5 ml) (Group-LS) or 12.5 mg of 0.5% isobaric levobupivacaine (2.5 ml)+ 1 mg nalbuphine (0.1 ml) + normal saline (0.4 ml) (Group-LN). Onset of sensory block, two segment regression time, time of regression to T12, duration of effective analgesia and intensity of motor block were assessed. Results: Onset of sensory block was comparable in the two groups (P=0.774). Time of regression of sensory block to T12 dermatome was 161.09 ± 40.50 min in group LS and 167.50 ± 50.17 min in group LN (P=0.633).The duration of effective analgesia was 177.39 ± 43.53 min in group LS and 183.75 ± 56.69 min in group LN (P=0.669).Motor block parameters were also comparable.More number of patients in group LN had a sedation score of one as compared to group LS. No major side effects were seen. Conclusion: 12.5 mg levobupivacaine with or without nalbuphine is sufficient for conducting inguinal hernia surgeries. Intrathecal nalbuphine 1 mg did not affect the sensory and motor block characteristics of levobupivacaine.

Comparative study of intrathecal fentanyl and clonidine as adjuvants to hyperbaric bupivacaine under spinal anaesthesia in infraumbilical surgeries

Background: Opioids are commonly used neuraxial adjuvants with local anaesthetics in subarachnoid block (SAB) for prolongation of analgesia, however Clonidine has shown to improve the quality of blockade without any neurotoxicity. This study assess the quality of SAB using intrathecal fentanyl and clonidine with bupivacaine in infraumbilical surgeries. Methods: After obtaining ethical clearance and informed consent 80 patients were randomly allocated into 2 groups, Group F received 15µg fentanyl and group C received 30µg clonidine with 12.5mg hyperbaric bupivacaine each. The onset time to reach peak sensory and motor level, 2 segment regression time, total duration of motor and sensory blockade, time for first rescue analgesia, hemodynamic changes and side effects were recorded. Results: The patients in group C had significantly prolonged sensory and motor blockade and less and delayed requirement of rescue analgesic than in group F. Conclusion: Intrathecal clonidine as adjuvant is better than fentanyl as it prolongs motor and sensory block and reduced demand of rescue analgesic.

A comparative study of intrathecal clonidine VS dexmedetomidine in caesarean patients

Introduction: Spinal anaesthesia is the most commonly employed technique for Caesarean section. Many drugs such as opioids as intrathecal additives such have been widely studied found to be associated with respiratory depression, pruritis, etc. Upcoming studies on alpha-2 agonists as intrathecal additives have been found promising and will replace opioids soon. Knowledge on the efficacy of the individual a2 agonists over one another is lacking. So the aim of the study is to compare the spinal additive effect of dexmedetomidine and clonidine in pregnant patients for caesarean section. Materials and Methods: Ninety patients belonging to ASA group I and II of age group of 20 – 40 years were included in the study. Patients with PIH, Diabetes, Body weight above 100kg, Height less than 145 cm, Post spinal surgeries, spinal deformity, and known history of Coagulopathy and allergic to study drugs, documented IUGR, intrauterine anomaly and patients those who are not willing for spinal anaesthesia were excluded from the study. They were randomly allocated into three groups of 30 patients each, Group D where the patients received dexmedetomidine 5µg with bupivacaine 10mg, Group C where the patients received clonidine 15µg with bupivacaine 10mg and Group B where the patient received bupivacaine 10mg with 0.9% saline 0.5ml. The duration of the sensory and the motor blockade, two segment regression times, duration of the postoperative analgesia, sedation and neonatal wellbeing with maternal hemodynamic changes were studied. Results: Demographic characteristics and hemodynamic parameters were comparable between the three groups. The onset and maximal sensory block was faster in Dxm and clonidine groups (162±41.40;166±37.57) than control group (254.67±28.73) which was statistically significant. The two segment regression time was significantly shorter in control group (67.53±5.94) than Dxm and clonidine group (103.47±8.08;108±6.90). Dxm and clonidine group showed shorter

Effects of addition of fentanyl and midazolam to local anaesthetic in lumbar epidural anaesthesia for infraumbilical surgeries

Introduction: Compared to general anaesthesia, regional anaesthetic techniques are more preferred in lower limb and lower abdominal surgeries as they have many advantages. Fentanyl a short acting opioid agonist, acts at µ receptor which is hundred times more potent than morphine. Fentanyl has many advantages compared to morphine because of its rapid onset of action and superior intra operative analgesia. Midazolam has an analgesic action by its action on the benzodiazepine GABA A receptor. Aim: The primary aim of the study was to compare the effect of two adjuncts to 0.5% bupivacaine through epidural anaesthesia. The study was directed towards the patients posted for infra umbilical surgeries. Materials and Methods: This study is conducted at Rajah Muthiah Medical College Hospital from august 2015- march 2016. Fifty patients posted for elective infra umbilical surgeries were divided into groups of 25 each. Group F received 18ml of 0.5% bupivacaine with 2 ml containing 100µg fentanyl and group M received 18ml of 0.5% bupivacaine with 2 ml of 2mg midazolam. Results: Both the groups maintained haemodynamic stability. Onset of sensory block was faster in group F (6.40 min) compared to group M (10.00min) which was statistically significant. The two segment regression time was found to be 150.8 min in group F compared to 147 min in group M. The mean duration of postoperative analgesia was significantly prolonged in group F (293.20min) when compared to group M (224.60min) with significant P value (0.05) Conclusion: Patients of fentanyl group exhibited prolonged duration of analgesia in comparison to midazolam group. Therefore fentanyl is more suited to midazolam in providing prolonged postoperative analgesia. Epidural fentanyl also produced faster onset of sensory blockade. There were no significant haemodynamic changes in both the groups. The occurance of nausea and vomiting was managed with a single dose of antiemetic. Keywords: Epidural anaesthesia, Fentanyl, Midazol

Study of spinal anaesthesia with isobaric levobupivacaine and ropivacaine in elective lower limb orthopaedic surgeries

Introduction and Objectives: Levobupivacaine and Ropivacaine, the two S enantiomers of Bupivacaine can be safer alternatives to racemic bupivacaine due to claims of cardiovascular safety profile. Hence, this study was conducted to assess the clinical efficacy of Levobupivacaine and Ropivacaine for spinal anaesthesia for orthopaedic surgeries of lower limbs. Methods and Materials: For this study, 60 adult ASA class I and II patients admitted for elective lower limb orthopaedic surgeries were randomised to 2 groups of n=30 each after approval from ethical committee and informed written consent. Spinal anaesthesia was given with 3ml Levobupivacaine 0.5% (15 mg) to patients in Group L and with 3ml Ropivacaine 0.5% (15 mg) to patients in Group R. Characteristics of spinal anesthesia in the two subsets like analgesia, motor blockade and hemodynamic parameters were observed and adverse effects, if any, were recorded. Data obtained were compiled and analysed with suitable statistical tests. A p-value of 0.05 was considered significant. Results: Onset of sensory and motor block were significantly faster in Group L (7 and 1.87 min) compared to Group R (9.43 min and 3.10 min). The maximum level of analgesia was attained faster in Group L (12.67 mins) compared to Group R (16.67 mins). The two segment regression time and the duration of analgesia were significantly shorter in Group R (72.63 min, 213.93 min) compared to Group L (103.6 min, 251.33 mins) Higher grade of motor blockade was achieved rapidly in Group L (9.03 mins) when compared to Group R (12.63 min). The mean duration of motor blockade was prolonged in Group L (263.67 mins) whereas recovery from motor blockade was earlier in Group R (151.17 mins). Both the groups had stable hemodynamics and adverse effects were not observed in both the groups. Conclusion: Intrathecal isobaric Levobupivacaine 15mg and Ropivacaine 15mg are effective in lower limb orthopaedic surgeries without significant haemodynamic changes. However,

Effects of intravenous dexmedetomidine on 0.5% hyperbaric bupivacaine spinal anesthesia - a placebo controlled randomized trial

Introduction and Aim: Dexmedetomidine, a neuraxial adjuvant, when given intrathecally with hyperbaric bupivacaine provides stable hemodynamic conditions, good quality of intraoperative and prolonged postoperative analgesia with minimal side effects. When intravenous dexmedetomidine is used in conjunction with neuraxial anesthesia, few studies have shown that it prolongs the sensory-motor blockade and provides better intraoperative and postoperative analgesia. We formulated this hypothesis that intravenous (IV) dexmedetomidine bolus followed by infusion would prolong the duration of subarachnoid block (SAB) with 0.5% heavy bupivacaine. Our aim was to assess the onset and duration of sensory and motor blockade following IV dexmedetomidine supplementation after SAB. Materials and Methods: Sixty American Society of Anesthesiologists Grade I and II patients undergoing elective surgeries under spinal anesthesia were randomized into two groups of 30 each. Immediately after subarachnoid block with 3 ml of 0.5% hyperbaric bupivacaine, patients in group II received a loading dose of 1 µg/kg of dexmedetomidine intravenously by infusion pump over 10 min followed by a maintenance dose of 0.5 µg/kg/hr till the end of surgery, whereas patients in group I received an equivalent quantity of normal saline. The time to reach peak sensory block level, time taken for two segment regression and maximum motor block, total duration of sensory and motor blockade, Ramsay sedation score and modified Bromage score were statistically analyzed using Statistical Package for Social Sciences (SPSS Inc. Chicago, IL, USA) Windows-based version 16.0. Results: Two segment regression time of sensory blockade was more in the dexmedetomidine group (130.33±14.49 mins) as compared to the normal saline group (94.67±15.02 mins) which was statistically significant (P Conclusion: The results of the present study shows that, intravenous dexmedetomidine given as a loading dose followed by maintenance dose

Effect of epidural volume extension with 7.5 ml of normal saline on sensory block for caesarean section

Spinal anaesthesia is considered the preferred anaesthetic technique for elective caesarean section as it avoids the risks of general anaesthesia related to difficult intubation and aspiration of gastric contents. Rescue strategies like changes in tilt of table are used to raise the level of an inadequate sensory block following intrathecal injection. This prospective, randomized, controlled study was conducted in 100 parturients, ASA1 or ASAII, with gestational age 38 weeks or more undergoing elective cesarean section under CSEA. Women were randomly distributed into two equal groups: Group A (CSE with no EVE), Group B (CSE followed by EVE using 7.5ml of normal saline). Time to reach maximum sensory block was significantly shorter in group B, Higher levels of sensory block were seen in group B (60% had T3-T4 block) whereas in group A, 64% had T5-T6 block. Group B and C had significantly higher levels of peak sensory block as compared to group A (p<0.001), two or more segments higher than the group A as assessed by temperature and pinprick. Two segment regression time of sensory block was significantly shorter in group A, whereas it was significantly longer in group B.

Comparison of Intrathecal Fentanyl and Butorphanol as an Adjuvant to Intrathecal Bupivacaine 0.5% in Infraumbilical Surgeries- A Randomised Double Blind Study

Introduction: Neuraxial opioids are widely used as adjuvants to local anaesthetic as they improve quality and duration of block. Neuraxial opioids like Butorphanol and Fentanyl allow prolonged analgesia in the postoperative period and faster recovery from spinal anaesthesia. Aim: To compare the safety and efficacy of Butorphanol and Fentanyl combined with bupivacaine for spinal anaesthesia in infraumbilical surgeries. Materials and Methods: The present study was a randomised controlled trial in which 110, ASA I and II patients of either sex who underwent elective infraumbilical surgeries under spinal anaesthesia were selected. Patients were allocated randomly into two groups A (n=55) and B (n=55). Group A (F) received intrathecal 0.5% hyperbaric bupivacaine 12.5 mg (3 mL) with fentanyl 25 microgram (0.5 mL) to make it total 3.5 mL. Group B (B) received intrathecal 0.5% hyperbaric bupivacaine 12.5 mg (3 mL) with butorphanol 250 microgram (0.25 mL) and Normal Saline (NS) 0.25 mL to make it total 3.5 mL. Heart Rate (HR), Systolic and Diastolic Blood Pressure (SBP, DBP), two segment regression time of sensory block, motor block were assessed at preset intervals. Chi-square test or Fischer’s-exact test were used and a p-value ≤0.05 was considered as statistically significant. Results: Mean of two segment sensory regression time of Group A was 41.94±1.73 minutes and Group B was 50.56±4.43 minutes (p&lt;0.0001). Time to onset of motor block in Group A was 5.28±.32 minutes and Group B was 5.27±.32 minutes (p=0.96). Mean duration of motor block in Group A was 81.23±4.87 minutes and Group B was 109.83±2.61 minutes (p&lt;0.0001). Time to rescue analgesic was 289.27±7.37 minutes in Group A and 378.41±10.25 minutes in Group B (p&lt;0.0001). HR, SBP and DBP were comparable among the groups. Conclusion: Intrathecal bupivacaine-butorphanol mixture was clinically better as it provided longer duration of analgesia with lesser incidences of pruritus and nausea/vomiting compared to intrathecal fentanyl-bupivacaine mixture.

A clinical comparative study between dexmedetomidine v/s clonidine with bupivacaine intrathecally in major orthopaedic lower limb surgery

Background: We compared intrathecal Bupivacaine with either Dexmedetomidine or Clonidine. Aims: 1. To review the literature 2. Sensory and Motor Characteristics and 3. Total duration of Post-op analgesia Material and Methods: 90 patients of either sex, age 20-50 years, ASA grade I or II undergoing orthopedic lower limb surgery were randomly divided in group D (0.5%Bupivacaine15mg+Dexmedetomidine3µg) and group C (0.5%Bupivacaine15mg+Clonidine30µg) intrathecally. All parameters were recorded. Results: Mean time for onset of sensory block at shin of tibia and onset of motor block were comparable. The mean time to achieve T10 sensory blockade was 5.822 ±2.38 minutes in group D while 6.5 ±2.33minutes in Group C. With regard to the highest sensory level attained, both groups were comparable. Mean time to achieve complete motor block was 8.177 ±2.124 minutes in group D while 9±2.044 minutes in group C. The time for two segment regression was also comparable in both the groups. The mean of total duration of motor block in group D was 254.44±40.65minutes compared to 262.22±34.23 minutes in clonidine group. The time for sensory block was 296.889±38.3063 minutes in group D and 306.22±35.63 minutes in group C. Total duration of postoperative analgesia was also same in both groups. Haemodynamic stability was maintained and side effects were comparable. Conclusion: We conclude that both Dexmedetomidine and Clonidine when used as an adjuvant to intrathecal hyperbaric Bupivacaine cause early onset of motor and sensory block, increases two segment regression time, prolonged motor, sensory blockade and post-operative analgesia with hemodynamic stability and no side-effects. Keywords: Dexmedetomidine, Clonidine, Bupivacaine, Intrathecal

English

INTRODUCTION: Epidural anesthesia was first performed by Spanish military surgeon Fidel Pages in 1921 in lumbar region. In 1949 Curbelo used Tuohy equipment for continuous blockade. The epidural technique became popular as it had some specific advantages over spinal anaesthesia. The feasibility of extended duration and differential blockade extended its application into other fields like post operative analgesia, chronic pain relief and obstetric pain relief. But some inherent negative points of epidural technique like delayed onset and patchy analgesia persist. Various attempts have been made to rectify these negative points. Combined spinal-epidural technique got introduced in an attempt to rectify this and has become popular. Various additive drugs have been tried along with local anaesthetics in an attempt to hasten the blockade to improve the quality of block. Among drugs that have been tried, magnesium sulphate deserves special mention. Even though magnesium sulphate has been used for various other purposes, its entry into anaesthetic arnamentorium is new. Magnesium sulphate has been described to possess various properties. The potentiation of local anaesthetic drugs is one among them. So my study aims to evaluate the effect of its addition to local anaesthetic in epidural blockade. Along with local anesthetic agent other additive drugs are Epinephrine, Clonidine, Dexmedetomidine, Neostigmine, Ketamine, and Benzodiazepines. Magnesium sulphate a potent antagonist of NMDA receptors when used epidurally is claimed to hasten the onset of sensory blockade. Magnesium also causes physiological Calcium channel blockade and decreases the postoperative opioid requirements. AIM OF THE STUDY: Sole epidural Bupivacaine is becoming unpopular due to delayed onset of sensory blockade. The aim of the study is to add magnesium sulphate as an adjunct to epidural Bupivacaine and evaluate 1. The impact of Magnesium sulphate on the quality of the block using the following parameters, a. Onset of sensory blockade, b. Motor blockade quality, c. Two segment regression time, d. Post-Operative analgesia. 2. Impact of Magnesium sulphate on hemodynamic changes. MATERIALS AND METHODS: After approval of the study by our institutional ethics committee, the study was conducted on 50 ASA grade I or II patients undergoing elective lower abdominal surgeries. Lumbar epidural anesthesia was performed to all the patients. The age of the patients ranged from 23- 70 weighing 45-80 kg and height ranging from 150 – 172 cm. all patients were thoroughly examines preoperatively. Informed consent was obtained from all of them. In the assessment room, vital parameters like pulse, blood pressure, and base line investigations like hemoglobin, urine analysis for albumin and sugar, blood sugar ,urea and creatinine and Electrocardiogram were checked. Thorough examination of all the systems and airway assessment was done. Exclusion criteria including significant co-existing diseases , long term analgesic use, and contraindications to regional anaesthesia such as local infection and bleeding diathesis. The patients were randomly allotted to 2 groups each containing 25. Group C: Patients received 19ml of 0.5 % Bupivacaine + 1 ml normal saline. Group S: Patients received 19ml of 0.5 % Bupivacaine + 50 mg of magnesium sulphate at L2-L3 space using 17G Tuohy needle and placing epidural catheter at 8 cm. SUMMARY: We conducted a double blinded randomized controlled study in 50 patients belonging to ASA I and II undergoing elective lower abdominal surgeries to evaluate the effect of adding magnesium sulphate to bupivacaine and bupivacaine alone in epidural anaesthesia in KAPV Govt Medical college hospital. For the same reason, we divided randomly the patients into two groups of 25 each. Group C received 19 ml of 0.5% of bupivacaine (95mg) and 1ml of Normal saline. Group S received 19 ml of 0.5% of bupivacaine (95 mg) and 1ml of Magnesium sulphate (50 mg). The total volume of the injected solution was 20 ml in both groups. The onset of sensory and motor blockade, the duration of post-operative analgesia were noted in the both the groups. Demographic data were similar in both the groups. We found the onset of sensory blockade was faster in the magnesium group. The duration of post-operative analgesia was slightly prolonged in the study group. The incidence of side effects were similar in both the groups. There is no difference in the change in heart rate and the episode of hypotension were also similar in both the groups. CONCLUSION: This study concludes that epidural magnesium sulphate when added to bupivacaine will shorten the onset of sensory blockade significantly in patients undergoing elective lower abdominal surgeries without increasing the incidence of side effects.

A comparison between intrathecal dexmedetomidine with hyperbaric bupivacaine and intrathecal fentanyl with hyperbaric bupivacaine in lower abdominal surgeries: A prospective double-blinded study

Background: The aim of this study is to compare the efficacy and safety of injection dexmedetomidine 5 μg and injection fentanyl when given intrathecally as adjuvant to injection bupivacaine in patients undergoing total abdominal hysterectomy in terms of the following parameters: (1) Characteristics of onset of sensory and motor block. (2) Characteristics of regression of sensory and motor block. (3) Level of sedation (4) Hemodynamic stability as assessed by pulse rate, systolic, and diastolic blood pressure (BP) and requirements of vasopressors. (5) Quality of postoperative analgesia as assessed by visual analog scale. (6) Evaluation of complications associated with injection dexmedetomidine and injection fentanyl when used as an adjuvant to injection bupivacaine. Materials and Methods: Ninety patients of the American Society of Anesthesiologists Class I and II posted for lower abdominal surgeries were allocated randomly into three groups of thirty patients each. C group: (n = 30) received 0.5 mL normal saline with hyperbaric bupivacaine 17.5 mg in 3.5 mL to make 4 mL. D group: (n = 30) received dexmedetomidine 5 μg with hyperbaric bupivacaine 17.5 mg in 3.5 mL diluted with 0.4 mL normal saline to make it 4 mL. F group: (n = 30) received fentanyl 25 μg with hyperbaric bupivacaine 17.5 mg in 3.5 mL to make 4 mL. Results and Conclusion: We observed that the groups were comparable with respect to demographic data (age, weight, height and duration of surgery) and onset time of sensory and motor blockade. The onset of sensory and motor block was slightly delayed in both groups. Two segment regression time of sensory blockade and time to reach Bromage scale 0 was greatly significant in dexmedetomidine and fentanyl. However, in comparison of the two, dexmedetomidine was clearly superior. The groups were comparable in terms of hemodynamic parameters, oxygen saturation, and respiratory rate, though there had been a statistically significant fall in BP and heart rate when compared to baseline. Sedation scores were found to be statistically significantly higher in group dexmedetomidine as compared to Fentanyl. The results showed statistically significant increase in the duration of postoperative analgesia in group using dexmedetomidine as compared to group fentanyl. The requirement of first rescue analgesic was greatly significant. The group using fentanyl had an postoperative pain free period of unto 4 h and dexmedetomidine had analgesia period unto 7 h. We found some adverse effects such as hypotension, bradycardia, nausea and vomiting with dexmedetomidine and fentanyl; however, the results were statistically insignificant. To conclude, the addition of dexmedetomidine prolonged the sensory and motor block significantly when used with hyperbaric bupivacaine intrathecally, to a much greater extent to the addition of fentanyl without increasing the incidence of significant adverse effects.