Level Of Sensory Block Research Articles

Intrathecal magnesium sulfate does not reduce the ED50 of intrathecal hyperbaric bupivacaine for cesarean delivery in healthy parturients: a prospective, double blinded, randomized dose-response trial using the sequential allocation method

BackgroundAddition of intrathecal magnesium sulfate to local anesthetics has been reported to potentiate spinal anesthesia and prolong analgesia in parturients. The current study was to determine whether intrathecal magnesium sulfate would reduce the dose of hyperbaric bupivacaine in spinal anesthesia with bupivacaine and sufentanil for cesarean delivery.MethodsSixty healthy parturients undergoing scheduled cesarean delivery were randomly assigned to receive spinal anesthesia with 0.5% hyperbaric bupivacaine and 5 μg sufentanil with either 0.9% sodium chloride (Control group) or 50% magnesium sulfate (50 mg) (Magnesium group). Effective anesthesia was defined as a bilateral T5 sensory block level achieved within 10 min of intrathecal drug administration and no additional epidural anesthetic was required during surgery. Characteristic of spinal anesthesia and the incidence of side effects were observed. The ED50 for both groups was calculated using the Dixon and Massey formula.ResultsThere was no significant difference in the ED50 of bupivacaine between the Magnesium group and the Control group (4.9 mg vs 4.7 mg) (P = 0.53). The duration of spinal anesthesia (183 min vs 148 min, P < 0.001) was longer, the consumption of fentanyl during the first 24 h postoperatively (343 μg vs 550 μg, P < 0.001) was lower in the Magnesium group than that in the Control group.ConclusionsIntrathecal magnesium sulfate (50 mg) did not reduce the dose requirement of intrathecal bupivacaine, but can extend the duration of spinal anesthesia with no obvious additional side effects.Trial registrationThis study was registered with Chinese Clinical Trial Registry (ChiCTR) on 15 Jul. 2014 and was given a trial ID number ChiCTR-TRC-14004954.

A comparative study of the effect of clonidine, fentanyl, and the combination of both as adjuvant to intrathecal bupivacaine for postoperative analgesia in total abdominal hysterectomy.

Background and Aims:The aim of this study was to evaluate the level of sensory block, onset and duration of motor block, postoperative analgesia, and adverse effects of combination of clonidine and fentanyl given intrathecally with hyperbaric bupivacaine (HB).Material and Methods:Three hundred and twenty eight patients were randomized into four groups. Group bupivacaine (group B) received 15 mg of HB; group bupivacaine clonidine (group BC) received 15 mg of HB plus 25 μg clonidine; group bupivacaine fentanyl (group BF) received 15 mg of HB plus 25 μg fentanyl and group bupivacaine clonidine fentanyl (group BCF) received 15 mg of HB plus 25 μg clonidine and 25 μg fentanyl intrathecally. All groups were evaluated for level of sensory block, onset and duration of motor block, postoperative analgesia, VAS score, sedation score and adverse effects of study drugs. All the data were analyzed using unpaired t-test. P < 0.05 was considered significant.Results:The level of sensory block, onset, and duration of motor block were comparable in all groups. Total duration of analgesia was 407.3 ± 20 min in group BCF compared to 242.1 ± 2 min and 209.2 ± 16 in groups BC and BF, respectively. Lesser doses of rescue analgesic were required in group BCF. The time interval from intrathecal injection to two-segment regression was statistically significant in study groups. Only 2.4% patients showed mild sedation in BCF group.Conclusion:We found that combination of intrathecal clonidine and fentanyl along with bupivacaine increases the total duration of analgesia without significant side effects.

Efficacy of Intravenous Ondansetron for Prevention of Postspinal Shivering during Lower Segment Cesarean Section: A Double-Blinded Randomized Trial.

Background and Aims:Elective lower segment cesarean section under spinal anesthesia is frequently associated with shivering. Ondansetron has been shown to be effective for postspinal shivering. In the present study, we compare the efficacy of ondansetron to prevent postspinal shivering in parturients undergoing cesarean delivery under spinal anesthesia.Materials and Methods:A total of eighty full-term parturients scheduled for elective lower segment cesarean section under spinal anesthesia were randomly allocated into two groups. Group O received 8 mg/4 ml ondansetron, and Group S received 4 ml normal saline intravenously immediately before induction of spinal anesthesia. The level of sensory block, core body temperature, shivering score, and presence or absence of nausea and vomiting during the perioperative period, 1st and 5th min neonates Apgar scores were recorded. The data analysis was carried out with Z-test and Chi-square test.Results:Ten percent (4/40) of patients in Group O and 42.5% (17/40) of patients in Group S had Grade III shivering during the perioperative period and that was treated with intravenous injection tramadol (P = 0.001). Two patients (5%) in ondansetron and 19 patients (47.5%) in control group had nausea and vomiting (P < 0.001) and was treated with intravenous 10 mg metoclopramide. 1st and 5th min Apgar scores of neonates were not statistically different in the groups.Conclusions:Ondansetron is an effective way to prevent shivering, nausea and vomiting during lower segment cesarean section under spinal anesthesia with no effect on Apgar score.

Effect of co-administration of different doses of phenylephrine with oxytocin on the prevention of oxytocin-induced hypotension in caesarean section under spinal anaesthesia: A randomised comparative study.

Introduction:Co-administration of phenylephrine prevents oxytocin-induced hypotension during caesarean section under spinal anaesthesia (SA), but higher doses cause reflex bradycardia. This study compares the effects of co-administration of two different doses of phenylephrine on oxytocin-induced hypotension during caesarean section under SA.Methods:In this prospective, double-blind study, 90 parturients belonging to the American Society of Anesthesiologists' physical status 1 or 2, undergoing caesarean section under SA were randomised into Group A: oxytocin 3U and phenylephrine 50 μg, Group B: oxytocin 3U and phenylephrine 75 μg, Group C: oxytocin 3U and normal saline, administered intravenously over 5 min after baby extraction. The incidence of hypotension (the primary outcome), rescue vasopressor requirement and side effects were recorded. Statistical analyses were with analysis of variance, Kruskal-Wallis, chi-square and Fisher's exact tests.Results:Demographic parameters such as age, height, weight, level of sensory block at 20 min and duration of surgery were comparable in all the groups. The incidence of hypotension (Group A – 90%, Group B – 10%, Group C – 98%, P = 0.001), magnitude of fall in mean arterial pressure (Group A-15.03 ± 6.12 mm of Hg, Group B – 6.63 ± 4.49 mm of Hg and Group C-13.03 ± 3.39 mm of Hg, P < 0.001) and rescue vasopressor requirement (Group A-45 ± 15.25 mg, Group B-5 ± 15.25, Group C-91.66 ± 26.53, P < 0.001) were significantly lower in Group B compared to A and C.Conclusion:Co-administration of phenylephrine 75 μg with oxytocin 3U reduces the incidence of oxytocin-induced hypotension compared to phenylephrine 50 μg with oxytocin 3U during caesarean section under spinal anaesthesia.

Comparison of Epidural Butorphanol with Neostigmine and Epidural Sufentanyl with Neostigmine for First Stage of Labor Analgesia: A Randomized Controlled Trial.

Background:Epidural administration of neostigmine appears to be safe in the obstetric population. Recently, few studies have concluded 10 μg sufentanil to be an effective adjuvant with epidural neostigmine in providing labor analgesia. However, no study has evaluated the analgesic effect of epidural butorphanol with neostigmine for the same.Materials and Methods:The parturients were randomly allocated to one of the three study groups - Group A (n = 30) received butorphanol 1 mg and neostigmine 7 μg/kg. Group B (n = 30) received sufentanil 10 μg and neostigmine 7 μg/kg. Group C (n = 30) received neostigmine 7 μg/kg and 0.9% normal saline. Maternal hemodynamic parameters and fetal heart rate (FHR) were continuously monitored. The level of sensory and motor block, and visual analog scale (VAS) pain score were recorded at designated time points. In addition, the total duration of analgesia, duration of labor, mode of delivery, and any maternal or fetal adverse effects were also recorded.Statistical Analysis Used:A one-way analysis of variance (ANOVA) with post hoc Tukey's test was used to compare mean value among the three groups for age, height, weight, gestational age, and cervical dilatation. Repeated measure ANOVA was used to compare mean difference among the time points and also the trend among the various time points for hemodynamic parameters, VAS pain score, and FHR. For inter-group comparison among the groups, post hoc Tukey test was used.Results:There was a statistically significant longer effect of analgesic drug in Group B with respect to Group A and C (P < 0.001); however, the parturient in Group C had minimum duration of analgesia. Epidural neostigmine combined with sufentanil produces effective analgesia in early labor (VAS <30 within 10 min in 63.3% of parturient and within 15 min in 83.3% parturient) with average duration of 111.67 ± 24.51 min without motor block or other side effect in mother and fetus. No significant effect was observed in the duration of labor and mode of delivery in-between the two groups, and none of the patients in any group had any maternal or fetal side effects.Conclusion:Epidural combination of sufentanil with neostigmine provided better pain relief in terms of the total duration of analgesia and the reduction in VAS pain scores at various time points in the initial 30 min of epidural administration of drugs during the first stage of labor in parturient when compared to the epidural combination of butorphanol with neostigmine.

Comparative study of midazolam, dexmedetomidine, and ketamine as an adjuvant to lidocaine in intravenous regional anesthesia for forearm and hand surgeries

Background Intravenous regional anesthesia (IVRA) is an ideal method of providing anesthesia for minor surgical procedures to the extremities performed on an ambulatory basis. This study aimed to study the effects of adding midazolam, dexmedetomidine, or ketamine as an adjuvant to lidocaine in IVRA during forearm and hand surgeries and examine their benefits and complications. Patients and methods A total of 120 patients were included, aged 40–60 years (American Society of Anesthesiologists physical status I–II), undergoing hand and forearm, from April 2015 to August 2016. Patients were randomly divided into four equal groups. Lidocaine-only group (LL group) received IVRA using 40 ml of lidocaine 0.5% (3 mg/kg). Lidocaine plus midazolam group (LM group) received IVRA using 40 ml of lidocaine 0.5% (3 mg/kg) plus midazolam 50 µg/kg added as an adjuvant. Lidocaine plus dexmedetomidine group (LD group) received IVRA using 40 ml of lidocaine 0.5% (3 mg/kg) plus dexmedetomidine 1 µg/kg added as an adjuvant. Lidocaine plus ketamine group (LK group) received IVRA using 40 ml of lidocaine 0.5% (3 mg/kg) plus ketamine 0.5 mg/kg added as an adjuvant. The time of onset, duration, and quality of analgesia; levels of sensory and motor block; heart rate; mean arterial blood pressure; and visual analog score were recorded. Adverse effects of hematoma, injection pain, skin erythema, sedation, and hallucinations were recorded. Results The onset time of sensory and motor blocks was significantly shorter in the adjuvant groups LM, LD, LK in comparison with the control group LL. The grade of sensory and motor blocks was significantly better in groups LM, LD, and LK in comparison with the LL group. The onset time of tourniquet pain was significantly shorter in the control group LL in comparison with adjuvant groups LM, LD, and LK. There was a significant increase in fentanyl requirements in the control LL group compared with adjuvant LM, LD, and LK groups. The duration of postoperative analgesia was significantly prolonged in adjuvant groups LM, LD, and LK compared with the control LL group. Hematoma, injection pain, cutaneous erythema, and hallucination were reported as postoperative complications. Conclusion The addition of midazolam, dexmedetomidine, or ketamine to lidocaine for IVRA improved the quality of intraoperative and postoperative analgesia with minimal adverse effects and higher patients and surgeon satisfaction.

Different low doses of levobupivacaine 0.5% with nalbuphine in spinal anesthesia for transurethral resection of prostate surgery

Background Subarachnoid block is a widely used technique for transurethral resection of the prostate (TURP) surgery in elderly, especially in those with respiratory and cardiac problems.Aim The aim of this study was to evaluate the efficacy of different low doses of levobupivacaine 0.5% when they are combined with nalbuphine in spinal anesthesia for TURP surgery, their efficiency for postoperative analgesia, and its side effects.Patients and methods A total of 90 patients older than 60 years of age and American Society of Anesthesiologists physical status I–III who underwent TURP under spinal anesthesia were enrolled. Patients were randomly divided into two groups: group I received intrathecal injection of 5 mg levobupivacaine 0.5% and 1 mg nalbuphine in 1 ml normal saline as total volume of 3 ml and group II received intrathecal injection of 7.5 mg levobupivacaine 0.5% and 1 mg nalbuphine in 0.5 ml normal saline as total volume of 3 ml. Patients were assessed for sensory and motor block characteristics, postoperative visual analog pain scale, and side effects.Results Patients in group II had earlier onset of sensory block at T10, longer duration of sensory and motor block and two-segment regression times, higher level of maximum sensory block, higher Bromage score at the end of surgery, and lower visual analog pain scale in the early postoperative period.Conclusion Levobupivacaine 0.5% of 5 and 7.5 mg with the addition of 1 mg nalbuphine are considered to be convenient for clinical use in TURP surgery with spinal anesthesia. Levobupivacaine of 7.5 mg had a better sensory block quality and prolonged early postoperative analgesia with similar hemodynamic stability without increasing complications.

Comparison of Intravenous Dexmedetomidine with Midazolam in Prolonging Spinal Anaesthesia with Ropivacaine

Midazolam and dexmedetomidine both being sedatives, but the latter with additional analgesic properties is expected to prolong the duration of sensory and motor block obtained with spinal anaesthesia. To compare intravenous dexmedetomidine with midazolam and placebo with respect to sensory and motor block duration, analgesia, and sedation in patients undergoing lower limb and lower abdominal surgeries with intrathecal ropivacaine anaesthesia. In this single blind placebo controlled trial, 60 patients, classified as American Society of Anaesthesiologists' (ASA) physical status I-II, were randomized into three groups (n=20 per group). All patients were administered ropivacaine (15 mg) for spinal anaesthesia. Intravenous dexmedetomidine was administered in Group D (1 μg/kg loading dose over 10 minutes, followed by a continuous infusion (0.5 μg/kg/hr), intravenous midazolam was administered in Group M (0.05 mg/kg) loading dose, followed by a continuous infusion (0.02 mg/kg/hr) and normal saline was infused in Group C. Intraoperative haemodynamic changes, onset, level and duration of sensory block, onset and duration of motor block, level of sedation, postoperative analgesia and side effects were recorded. Heart rate was seen to fall significantly in Group D patients for the first 15 minutes. Measurements of mean blood pressure revealed significant decrease in Group D after 40 minutes, whereas the fall in Group C occurred after 15 minutes. Duration of sensory block was significantly longer in Group D patients (208±19.358 mins) as compared to Group M and C where the duration was (177±15.252 mins) and (177±17.800 mins) respectively. Higher levels of sedation were achieved in Group D and M where sedation score was 3 (fully asleep but arousable), 90% cases in Group D and 100% cases in Group M. The time at which first analgesic was given to patients (VAS score 4) was (271.50±21.831) in Group D and (202±25.047) in M and (218.50±38.013) in Group C. Dexmedetomidine significantly prolongs duration of analgesia providing pain relief in intraoperative and postoperative period. Injection of diclofenac sodium 75 mg intramuscular was used as rescue analgesic. The VAS score reached a value of 4 earlier in the midazolam and saline group than dexmedetomidine group. Intravenous dexmedetomidine prolonged spinal anaesthesia, though midazolam did not. It also provided sedation and additional analgesia. Therefore, dexmedetomidine is appropriate during spinal anaesthesia, although heart rate needs to be monitored cautiously.

To Compare the Effects of Different Doses of Dexmedetomidine on Intrathecal Bupivacaine in Infraumbilical Surgeries: A Prospective, Randomized, Double-blind Clinical Study.

Introduction:Spinal anesthesia is preferred technique of choice in infraumbalical surgeries. Limitation of this technique is shorter duration of analgesia, so various adjuvants have been used with intrathecal bupivacaine such as fentanyl, clonidine, and dexmedetomidine. Dexmedetomidine is a highly selective alpha 2 adrenergic agonist. The aim of our study was to know the effect of different doses of dexmedetomidine on intrathecal bupivacaine.Materials and Methods:The prospective, randomized, double-blind study was conducted in tertiary health care center, on ninety patients of the American Society of Anesthesiology Class I and II, of age group 18–60 years of either sex. They were randomly allocated into three groups. Group BD5 (n = 30): intrathecal bupivacaine 12.5 mg (2.5 ml) + dexmedetomidine 5 μg (0.5 ml), Group BD10 (n = 30): intrathecal bupivacaine 12.5 mg (2.5 ml) + dexmedetomidine 10 μg (0.5 ml), Group BD15 (n = 30): intrathecal bupivacaine 12.5 mg (2.5 ml) + dexmedetomidine 15 μg (0.5 ml) administered intarthecally. The onset and maximum level of sensory block, time to reach maximum level of sensory block, time of two-segment sensory regression, the total duration analgesia, time of rescue analgesia, onset and duration of motor block and heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, respiratory rate, and oxygen saturation were recorded at various intervals. Moreover, any adverse effects such as bradycardia, hypotension, nausea, vomiting, and sedation were recorded.Results:The onset time of sensory block in Group D5-2.76 ± 1.32, Group D10-2.45 ± 1.50, and Group D15-1.86±0.93, which is statistically significant (P = 0.025). The time taken for two-segment sensory regression Group D5-96.66 ± 33.67, Group D10-116.80 ± 36.27, and Group D15 120.96 ± 30.24, (P = 0.014). The time taken for complete sensory recovery in Group D5-319.83 ± 61.41, Group D10-336.13 ± 61.38, and Group D15-415.20 ± 96.6, which is statistically highly significant (P = 0.000). Time for rescue analgesia in Group D5-377.46 ± 60.05, in Group D10-401.60 ± 61.11, and in Group D15-517.96 ± 97.30, which is statistically highly significant (P < 0.000).Conclusion:We concluded that there was decrease in onset of sensory and motor blockade with the prolongation of duration of anesthesia and analgesia in a dose-dependent manner.

Low-dose intravenous alpha-2 agonists as adjuvants to spinal levobupivacaine: A randomized study

Background: Alpha-2 agonists have been used with spinal anesthesia for anxiolysis, analgesia, and hypnosis and for postoperative pain relief. These beneficial effects may, however, be offset by their propensity to prolong the duration of motor block and adversely affect hemodynamics when used in higher doses. This study compares the effects of low-dose premedication with intravenous (IV) dexmedetomidine and IV clonidine with placebo, on spinal blockade duration, analgesia, and sedation with intrathecal levobupivacaine. Materials and Methods: In this prospective, randomized, double-blinded, placebo-controlled study, ninety American Society of Anesthesiologists Status I and II patients were randomly allocated into three groups: Group A (control) received 10 ml normal saline IV, Group B received IV dexmedetomidine 0.6 μg/kg, and Group C received IV clonidine 1.2 μg/kg over 10 min, before spinal anesthesia with 0.5% levobupivacaine. Hemodynamics, total duration of analgesia, onset and duration of sensory and motor block, visual analog scale score, and sedation score were assessed. Complications, if any, were noted. Results: The level of sensory block achieved was higher with dexmedetomidine (T4.2 ± 0.8) and clonidine (T4.4 ± 0.7) as compared to control (T5.1 ± 0.7; P

A comparative study of hyperbaric bupivacaine (0.5%) with hyperbaric levobupivacaine for spinal anesthesia in cesarean section: A randomized, controlled trial

Background: Spinal anesthesia is often used for both elective and emergency cesarean section. One earlier study has shown that intrathecal levobupivacaine given in L 3-4 space did not provide satisfactory intraoperative analgesia in all parturients. We assume that the same dose may work if given in L 2-3 intrathecal space, especially in our population with shorter stature. Materials and Methods: After Institutional Ethical Committee approval, 100 parturients (American Society of Anesthesiologists I-II, aged 18-40 years) and after obtaining written informed consent to received spinal anesthesia for cesarean section were randomized into four groups: Group I (0.5% hyperbaric bupivacaine 7.5 mg in L 2-3 intrathecal space), Group II (0.5% hyperbaric levobupivacaine 7.5 mg in L 2-3 intrathecal space), Group III (0.5% hyperbaric bupivacaine 10 mg in L 3-4 intrathecal space), and Group IV (0.5% hyperbaric levobupivacaine 10 mg in L 3-4 intrathecal space), respectively. Hypotension (systolic blood pressure 20% from baseline) was treated with injection mephentermine 3 mg intravenous (iv) increment (s). For the ethical reason, inadequate analgesia was treated with 0.5 mg/kg iv ketamine. Statistical analysis was performed using the SPSS version 20 software windows. A P < 0.05 was considered significant. Results: Time to onset of sensory block was faster in 0.5% hyperbaric levobupivacaine 10 mg given in L 3-4 intrathecal space (Group IV P = 0.013). No significant difference was found in time to reach maximum block level (T 4 -T 6 ). Median peak sensory block level was significantly lower in Group II as compared with other group T 6 versus T 4 ; F = 106.159; P < 0.001). Time to regression by two dermatomes was significantly shorter with a lower dose of either bupivacaine or levobupivacaine given at L 2-3 intrathecal space (P = 0.028). The degree of motor block or motor block regression was similar in all the groups. Intraoperative rescue analgesia was required in 20% of patients in Group II (levobupivacaine 7.5 mg in L 2-3 ); it was 4% in each of the remaining groups (P = 0.082). Injection mephentermine used was 24%, 32%, 48%, and 28%, respectively, in Group I to IV though it did not reach statically significance. Conclusion: Levobupivacaine 7.5 mg can be used in lower segment cesarean section when given in L 2-3 space. Onset is faster, and hemodynamic stability is more with levobupivacaine. At the higher dose, the duration of action bupivacaine seems to be longer.

Comparison of the Efficacy and Safety of Morphine and Fentanyl as Adjuvants to Bupivacaine in Providing Operative Anesthesia and Postoperative Analgesia in Subumblical Surgeries Using Combined Spinal Epidural Technique.

Introduction:The combined spinal epidural (CSE) technique involves intentional subarachnoid blockade and epidural catheter placement during the same procedure to combine their individual best features, to reduce the total drug dosage and avoid their respective disadvantages. The addition of opioids to local anesthetics (bupivacaine) for CSE anesthesia (CSEA) is increasingly common to enhance the block. Neuraxial fentanyl is more potent and has shorter duration of action than morphine which provides prolonged anesthesia and analgesia, however at the cost of increased incidence of adverse effects like delayed respiratory depression.Aims and Objectives:The aim is to compare the efficacy and safety of morphine and fentanyl as adjuvants to bupivacaine in subumblical surgeries using CSE technique. The characteristics of sensory and motor block, intergroup variations in pain, cardiorespiratory parameters, and adverse effects were compared between the two groups.Materials and Methods:A total of 60 patients belonging to physical status American Society of Anesthesiologists Classes I and II, aged 18–60 years were randomized into two groups: Group A (n = 30) received intrathecal 0.5% heavy bupivacaine 12.5 mg and morphine 2.85 μg/kg; Epidural Anesthetic bolus (when required/T11Regression) 8 ml 0.25% isobaric bupivacaine and 0.04 mg/kg morphine; Epidural Analgesic bolus (postoperative visual analog scale [VAS] score >30) 5 ml 0.125% isobaric bupivacaine and 0.04 mg/kg morphine and Group B (n = 30) received intrathecal 0.5% heavy bupivacaine 12.5 mg and fentanyl 0.35 μg/kg; Epidural Anesthetic bolus (when required/T11Regression) 8 ml 0.25% isobaric bupivacaine and 0.7 μg/kg fentanyl; Epidural Analgesic bolus (postoperative VAS score >30) 5 ml 0.125% isobaric bupivacaine and 0.7 μg/kg fentanyl.Results and Conclusion:Group A had significantly prolonged two segment regression time, T11 regression time, lower mean VAS score, prolonged effective analgesia, and required lesser number of epidural boluses in 24 h as compared to Group B (P < 0.001). There were no significant differences between the groups considering onset of sensory block, duration of motor block, median maximum sensory block level achieved after spinal component (T6), median highest sensory block level achieved after epidural anesthetic bolus (T7-4seg enhancement after regression to T11), cardiorespiratory parameters and adverse effects. None of the patients had respiratory depression nor was there any failure of spinal/epidural component of CSEA. Thus, addition of morphine to bupivacaine in CSEA produced prolonged effective anesthesia and postoperative analgesia compared to addition of fentanyl to bupivacaine without producing undue adverse effects.

Effects of intrathecal dexmedetomidine as an additive to low-dose bupivacaine in patients undergoing transurethral resection of prostate.

Background and Aims:In patients undergoing transurethral resection of prostate (TURP), it is vital to restrict the level of block to T10dermatome during spinal anaesthesia. Low-dose bupivacaine causes minimum haemodynamic alterations, but may provide insufficient surgical anaesthesia. Dexmedetomidine, a selective α2-adrenoreceptor agonist, is a potent anti-nociceptive agent when given intrathecally. The aim of this study was to compare the adjuvant effects of intrathecal dexmedetomidine with low-dose bupivacaine spinal anaesthesia versus a higher dose of bupivacaine in patients undergoing TURP.Methods:The study was designed as a prospective, double-blind, randomised trial that included sixty patients of American Society of Anesthesiologists Grade I–III scheduled for TURP. They were allocated into two groups: Group I receiving only hyperbaric bupivacaine intrathecally and Group II receiving dexmedetomidine with low dose bupivacaine. The time to regression of two dermatomes from the peak sensory block level was the primary outcome of the study.Results:With comparable baseline and demographic attributes, both groups had similar peak sensory block levels (T9). Patients in Group II had quicker onset with the time to reach T10being faster (10.72 ± 3.50 vs. 12.72 ± 3.90 min, P = 0.041), longer duration of motor block (200 ± 18.23 vs. 190 ± 10.15 min, P = 0.011) and increased time to first analgesic requirement (300 ± 25.30 vs. 220 ± 15.12 min, P = 0.0001).Conclusion:Intrathecal dexmedetomidine with low-dose bupivacaine provides faster onset, prolonged sensory and motor block and reduced rescue analgesic requirement in patients undergoing TURP.

Combined spinal-epidural anesthesia with hypobaric ropivacaine in sitting position significantly increases the incidence of hypotension in parturients undergoing cesarean section.

Maternal position during induction of combined spinal-epidural anesthesia (CSEA) may affect hemodynamics and block characteristics. This study aimed to assess whether the sitting position is more likely to induce hypotension and higher block level than the lateral position in CSEA with hypobaric ropivacaine. Ninety American Society of Anesthesiologists physical status I and II parturients undergoing elective cesarean section were randomized into three groups: the sitting, left-lateral, and right-lateral position groups. The L3-4 interspace was selected as the puncture site, and subarachnoid injection of 2.5 mL 0.5% hypobaric ropivacaine was administered. After the epidural catheter was inserted and fixed, the patient's position was changed to the left-leaning supine position. The blood pressure was measured once every 1 min followed by once every 3 min after the delivery. The sensory block level was regularly measured. A total of 88 parturients were included in this study. The incidences of hypotension in the sitting, left-lateral, and right-lateral position groups were 72%, 38%, and 40%, respectively, P = 0.012. Incidence and total dose of the phenylephrine supplement in the sitting position group were significantly higher than in the other two groups. The sitting position group showed a significantly higher block level (T4 [T3, T4]) as compared to the left-lateral (T6 [T5, T6]) and right-lateral position groups (T6 [T4, T6]), P < 0.01. The Apgar scores of neonates at 1 min and 5 min, and the pH values of the umbilical arterial and venous blood were similar among the three groups. As compared to the lateral positions, CSEA with hypobaric ropivacaine in the sitting position is more likely to cause hypotension and excessively high block level.

Preoperative measurement of maternal abdominal circumference relates the initial sensory block level of spinal anesthesia for cesarean section: An observational study

ObjectiveLumbosacral cerebrospinal fluid volume is decreased as the enlarging uterus compresses the inferior vena cava during pregnancy. A subsequent greater cephalad spread of sensory blockade is observed. Gravid uterus plays a crucial role in affecting the spinal anesthesia level. We hypothesized that maternal abdominal circumference can reflect compressive effect of the uterus and investigated the relationship between abdominal circumference and the level of sensory blockade, and incidence of hypotension following spinal anesthesia with hyperbaric bupivacaine in term parturients. Materials and MethodsForty-two term parturients scheduled for elective cesarean section were studied. Abdominal circumference was measured before spinal anesthesia; 0.5% hyperbaric bupivacaine (2 mL, 2.2 mL, or 2.4 mL) was injected in to the subarachnoid space at the L3–L4 intervertebral level according to the parturient's height. The level of sensory blockade was assessed using an ice cube 1 minute, 5 minutes, 10 minutes, and 15 minutes after the spinal injection. The level of sensory blockade at the 15th minute was defined as the level of maximum sensory blockade. Statistical correlation coefficients were evaluated with Spearman's rank correlation. ResultsThe correlation coefficient between the abdominal circumference and spinal level measured by cold sensation loss at 5 minutes after spinal anesthesia was significantly positive (right side ρ=0.43, p=0.005; left side ρ=0.46, p=0.003). No significant correlation was found between abdominal circumference and the level of maximum sensory blockade, the incidence of hypotension, ephedrine dosage, nausea, and vomiting after spinal anesthesia. ConclusionParturients with greater abdominal circumference value have a higher level of sensory blockade at 5 minutes after spinal anesthesia. Abdominal circumference cannot predict the maximum sensory blockade level and the incidence of hypotension.

Spinal Anesthesia for Transurethral Resection of Prostate: Levobupivacaine with or without Fentanyl

Background: The aim of the present study was to compare the characteristics of spinal blocks produced by low dose levobupivacaine (0.5%) and compare it when combined with fentanyl in transurethral resection of prostate. Methods: With Institutional ethical committee clearance a prospective, randomized, double-blinded study conducted. After obtaining informed written consent a total of 140 patients scheduled for elective TURP were randomly allocated into one of the two groups of 70 patients each. Following a spinal tap, patients in Levobupivacaine Group(L) received 1.5 ml of 0.5% isobaric levobupivacaine and in Levobupivacaine - Fentanyl Group (LF) received 1 ml of 0.5% isobaric levobupivacaine with fentanyl 25 μg (0.5 ml) intrathecally. The characteristics of sensory and motor block, hemodynamic data, side effects, patient and surgeon satisfaction were recorded. Results: There were no significant differences between the two groups for patient demographic, intraoperative hemodynamic parameters, side effects and satisfaction. The highest level of sensory block was T9 in the Group L, and T8 in the Group LF (p = 0.001). Duration of motor block was shorter in Group LF than in Group L (154.76 ± 16.39 minutes in Group L; 136.23 ± 9.06 minutes in Group LF) (p = 0.001). Conclusion: Both regimes are effective, and the addition of fentanyl to levobupivacaine may offers prolong duration of sensory block and postoperative analgesia and the advantage of shorter duration of motor block, thus it may be used as an alternative to pure levobupivacaine solution in spinal anaesthesia, for transurethral resections.

Unilateral Sensitive Spinal Anesthesia. Case Report

A 46-year-old male was admitted for tenolisys of anterior compartment of lower leg under spinal anesthesia. Spinal puncture was performed with the patient in the lateral left side, in the L3-L4 using 27 G needle, and 4 mg of 0.1% hypobaric bupivacaine were administered. The patient remained in that position for 10 min. In the limb to be operated, the level of sensory block was observed in L1 without motor block. With this new technique that was obtained surgical analgesia, but without motor blockade. We call this new technique of unilateral sensitive spinal anesthesia.

Hypobaric versus isobaric spinal levobupivacaine for total hip arthroplasty.

Spinal anesthesia (SA) in the lateral decubitus position is often used to perform total hip arthroplasty (THA). Hypobaric local anesthetic ensures enhanced and prolonged sensory and motor block in the involved side. The aim of this study was to compare the intraoperative anesthetic efficacy of hypobaric with isobaric levobupivacaine solutions for THA. Forty patients scheduled to elective THA were allocated into two groups: isobaric levobupivacaine group (IL group) and hypobaric levobupivacaine group (HL group). All the patients were placed with the operative side uppermost on the surgical table and spinal anesthesia was performed with 4 mL (12.5 mg) of selected solution. The evolution of sensory and block on nondependent (operative) and dependent sides were checked. Regarding the nondependent side the onset times for maximal sensory block level in the in HL group was 17.8±1.1 minutes vs. 24.2±4.1 minutes in IL group. In HL group the onset time for motor block was 9.2±3.5 minutes vs. 15.6±5.4 minutes in IL group. The sensory regression time to L2 was significantly prolonged in HL group (192±30.3 minutes vs. 111±13.4 min). After surgery in HL group the residual motor block degree was 2.4±0.9 vs. 0.2±0.4 in IL group. In patients undergoing THA under spinal anesthesia 12.5 mg of hypobaric levobupivacaine, compared with the same dose of isobaric levobupivacaine, allow shorter onset time for sensory block and delayed regression of sensory and motor block in the nondependent side.

English

English

Abstract PR200

Background & Objectives: Patient position after spinal anesthesia had variable effects on hemodynamic stability, sensory and motor blocks level. The aim of this study was to determine the effects that sitting the patient up for three minutes or one minute after spinal anesthesia would have on perioperative hemodynamic measurament, ephedrine, requirement, sensorial and motor blocks levels and postoperative recovery. Materials & Methods: Ninety parturients undergoing elective cesarean delivery under spinal anesthesia were enrolled in this prospective randomized controlled trial. After the spinal injection, the women were randomized either to sit up for three minutes (Group 3) or one minute (Group 1) then lie down or to lie down immediately (Group 0) to a tilted supine position. Hemodynamics, including the incidence of hypotension, ephedrine dose required, and characteristics of the sensory and motor blocks were analyzed. Results: Parturients characteristics were similar in all groups. The incidence of hypotension and the required dose of ephedrine were lower in Group 3 compared to Group 1 and Group 0 (p<0.01 and p< 0.001). Group 3 had a lower intraoperative sensory block height than Group 1 and Group 0 (T4 [T2-6] vs T2 [T1-T6] and T2 [C7-T6], respectively; p< 0.001). In Group 0, the time to achieve maximal sensory block level was shorter than in Group 3 and Group 1 (7.8±4 min vs 11±3 min and 13±6 min, respectively, p< 0.05). Time to a Bromage score of 2 was longer in Group 3 than in other groups. There were no differences in Apgar scores between groups (p = 0.121). Conclusion: We demonstrated that when parturients undergoing cesarean delivery were maintained in the sitting position for three minutes after spinal injection of the local anesthetic resulted in sensory block levels, incidence of hypotension and ephedrine requirements that were lower compared with other groups.