Shorter Duration Of Motor Block Research Articles

A comparative study of intrathecal isobaric ropivacaine and hyperbaric bupivacaine for elective lower segment caesarean section

Background: The study was to compare intrathecal isobaric ropivacaine and hyperbaric bupivacaine in terms of onset of sensory block, maximum height of sensory block, total sensory duration, onset of motor block, degree of motor block and duration of motor block, quality of anesthesia. Methods: The 100 cases of ASA II undergoing elective lower segment caesarean section were taken for the study and divided into two groups. Group B patients received 2 ml of hyperbaric bupivacaine intrathecally. Group R patients received 2ml of isobaric ropivacaine intrathecally. Patients were evaluated for onset and duration of sensory block, onset and duration of motor block, maximum height of sensory block, quality of anaesthesia, time to request for analgesia, hemodynamic parameters and side effects if any were studied. Results: There were no significant differences between the two groups in mean time to onset of sensory block. Maximum sensory height attained in group B ranged between T4 and T6, where as in group R, it ranged between T2 and T6 which was clinically and statistically highly significant (p<0.001). Total duration of sensory block in group B and in group R, which is not significant (p=0.068). Mean time onset of motor block was 4min in group B and 8 min in group R, (p<0.001). Duration of motor block was 155.20±14.95 min in group B and 94.10±8.31 min group R, which is clinically and statistically significant (p<0.001). Conclusions: Ropivacaine 15 mg (2 ml of 0.75% isobaric ropivacaine) provides comparable quality of sensory block but has slower onset and significantly shorter duration of motor block compared to bupivacaine.

Comparison of efficacy of intrathecal hyperbaric ropivacaine and hyperbaric bupivacaine in terms of enhanced recovery after surgery (ERAS) for ACL reconstructions

: Bupivacaine is the drug of choice in spinal anaesthesia (SA), while Ropivacaine with its comparatively shorter duration of motor block allows early mobilization post ACL reconstruction surgery which is a crucial factor in Early Recovery after Surgery. : In this randomized double-blind comparative study of a total of 60 patients irrespective of gender undergoing ACL reconstruction surgery were studied. After Administration of SA to group R (2.5ml of 0.75% Heavy Ropivacaine) & group B (2.5ml of 0.5% Bupivacaine) both were compared for their post-operative effects with Bromage score, Aldrete score & Visual Analogue Score. : The time required for complete regression of motor blockade in group R (144.5+26.1 mins) < group B (181±21.3mins) which allowed for early mobilization which over all provides better and faster recovery.: Hyperbaric Ropivacaine when compared to Bupivacaine promises better results in terms of early ambulation and intraoperative hemodynamic stability promoting ERAS in patients undergoing ACL reconstruction surgeries. Promoting ERAS policy will reduce the duration of hospital stay, thereby improving the cost-effectiveness of health services.

Comparison of efficacy of nalbuphine-levobupivacaine combination with levobupivacaine alone in ultrasound-guided supraclavicular brachial plexus block in upper limb orthopedic surgeries

Abstract Background and Aims: Brachial plexus block is a widely used approach for upper limb surgeries as an alternative to general anesthesia to achieve ideal operating conditions by providing adequate muscle relaxation and maintaining intraoperative hemodynamic stability. Ultrasound-guided supraclavicular brachial plexus block provides intraoperative anesthesia and postoperative analgesia. It reduces many complications such as intravascular injection pneumothorax. Levobupivacaine is preferable over bupivacaine due to its lower cardiotoxicity, prolonged sensory block, and shorter duration of motor block. Materials and Methods: A prospective, hospital-based, double-blinded, randomized, controlled, comparative study was planned on 80 adult patients of either sex belonging to the American Society of Anesthesiologists Class 1 and 2 undergoing upper limb orthopedic surgeries. Group L – 24 mL levobupivacaine 0.375% (90 mg) + NS (1 mL) (total volume 25 mL) and Group LN – 24 mL levobupivacaine 0.375% (90 mg) +5 mg nalbuphine diluted with NS to 1 mL volume (total volume 25 mL). Duration of analgesia, onset, and duration of sensory block and motor block, hemodynamic changes, and total doses of rescue analgesia in 24 h were noted in both groups. Results: The duration of analgesia was significantly longer in Group LN (749.80 ± 9.70 min) as compared to Group L (641.20 ± 12.71 min) (P < 0.001). Onset of sensory block in Group LN (11.15 ± 0.83 min) is faster than in Group L is (13.30 ± 0.52 min) (P < 0.001). Onset of motor block in Group LN (13.68 ± 0.73 min) is faster than in Group L (16.33 ± 0.89 min) (P < 0.001). Hemodynamic parameters were comparable in both groups. There was no significant difference in adverse effects and complications. Conclusion: The addition of nalbuphine to levobupivacaine provides a longer duration of analgesia as compared to levobupivacaine alone.

Hyperbaric Prilocaine Versus Hyperbaric Bupivacaine for Spinal Anesthesia in Women Undergoing Elective Cesarean Section: A Comparative Rrandomized Double-blind Study

(Anaesthesia. 2021;76:777–784. [Epub January 11, 2021]) Spinal anesthesia is the standard technique for patients undergoing cesarean delivery (CD). Bupivacaine has been a mainstay for spinal anesthesia for decades due to its minimal onset time and extended duration of motor and sensory block. There are disadvantages, however, such as some effect variability between patients. Prilocaine is a newer local anesthetic and is expected to provide a shorter duration of motor block. The aim of this study is to compare the motor block durations of hyperbaric prilocaine and bupivacaine when used for spinal anesthesia in patients undergoing elective CD.

Spinal Anesthesia for Elective Cesarean Section – Comparison of Levobupivacaine and Ropivacaine with Hyperbaric Racemic Bupivacaine

Background: Spinal anesthesia is a popular technique for cesarean section, the commonly used drug being hyperbaric bupivacaine. Levobupivacaine and ropivacaine are newer local anesthetics in the Indian market with similar sensory block profile, lesser cardiotoxicity, but shorter duration of motor block. Aim: To determine the efficacy and safety of hypobaric levobupivacaine and ropivacaine and to compare it with hyperbaric bupivacaine all with fentanyl for spinal anesthesia in elective cesarean section. Study Design: This was a prospective, randomized controlled, double-blinded study. Methodology: Ninety pregnant patients were allocated to three groups of 30 each. Group A (control) received 0.5% hyperbaric bupivacaine 1.8 ml with 25 μg fentanyl, Group B (study) received 0.5% levobupivacaine 1.8 ml with 25 μg fentanyl, and Group C (study) received 0.75% ropivacaine 1.8 ml with 25 μg fentanyl. The efficacy and safety were assessed and analyzed using SPSS version 22. Results: Our study showed that ropivacaine is noninferior to hyperbaric bupivacaine, with a similar efficacy of 96.7%. Hyperbaric bupivacaine and ropivacaine are superior to levobupivacaine with a success rate of 96.7% versus 80%, with a P = 0.02 for superiority (one-sided). Duration of motor block was shorter in levobupivacaine (P < 0.001) and ropivacaine (P = 0.016) groups compared to bupivacaine group. Mean duration of analgesia was shorter in levobupivacaine (P = 0.001) and ropivacaine (P = 0.010) groups when compared to bupivacaine group. Although the percentage of patients having hypotension were similar among the groups, episodes of intraoperative hypotension and the amount of ephedrine consumed were higher in ropivacaine group compared to bupivacaine group (P = 0.039). Conclusion: Ropivacaine 0.75% appeared noninferior to hyperbaric bupivacaine 0.5% in terms of efficacy and safety. Levobupivacaine 0.5% was found to be inferior to bupivacaine and ropivacaine in terms of efficacy.

Comparison of Haemodynamic Effects of Levobupivacaine and Bupivacaine in Sub-arachnoid Block for Total Abdominal Hysterectomy

Introduction: Altered haemodynamics and arterial hypotension are the most prevalent untoward effects of sub-arachnoid block with bupivacaine. Use of levobupivacaine as pure S (-) - enantiomer of bupivacaine has progressively increased due to its lower cardiotoxicity, neurotoxicity and shorter duration of motor block. This study aimed to compare the haemodynamic status of levobupivacaine and bupivacaine when used with fentanyl in Sub-arachnoid block (SAB) among patients undergone total abdominal hysterectomy.
 Materials and Methods: This randomized clinical trial enrolled 80 gynaecological patients scheduled for total abdominal hysterectomy under SAB. Forty patients were randomly assigned as trial group (levobupivacaine+fentanyl) and forty as control group (bupivacaine+fentanyl). Main outcome measures in both groups considered intraoperative haemodynamic stability (acute hypotension), cardiotoxicity (bradycardia or tachycardia) and time of administration of first dose of postoperative analgesics.
 Results: Bupivacaine caused comparatively more significant slowing of heart rate at 25 and 35 minutes of operation. Though no significant differences were found in systolic blood pressure between two groups, bupivacaine caused significant reduction of diastolic blood pressure in comparison to levobupivacaine at 6, 9, 45 minutes and at the end of surgery. Mean pressure found significantly lowered at 6 minutes and at the end of surgery following bupivacaine administration. The incidence of acute hypotension was significantly low in trial group and postoperative analgesia was maintained longer duration with levobupivacaine in control group.
 Conclusion: Levobupivacaine in comparison to bupivacaine showed more effective and satisfactory haemodynamic stability in sub-arachnoid block with less incidence of intraoperative acute hypotension and provides prolonged postoperative analgesic effect.
 Medicine Today 2020 Vol.32(1): 29-32

Cerebrospinal Fluid and Spinal Anesthesia Parameters in Healthy Individuals versus Opium-addict Patients during Lower Limb Surgery.

BackgroundStudies have reported lower pain threshold, spinal anesthesia duration, and level of sensory block in addicts compared to non-addict patients undergoing spinal anesthesia for surgery. Moreover, blood gas and cerebrospinal fluid (CSF) were likely to be affected as well. The aim in the present study is to evaluate CSF and spinal parameters in addict versus non-addict patients during lower limb surgery.MethodsIn this case-control study, 22 opium addicts and 22 sex- and age- matched non-addicts undergoing lower limb surgery under spinal anesthesia were included. The CSF parameters, venous blood gas (VBG), and sensory and motor block findings were compared between the groups.FindingsThe addict and non-addict patients were similar regarding CSF and blood gas parameters except higher pH in VBG (7.39 ± 0.06 vs. 7.33 ± 0.11, P = 0.030) and CSF (7.39 ± 0.06 vs. 7.33 ± 0.11, P = 0.030) for addict patients. The addict patients had significantly later onset of sensory block (5.72 ± 1.57 vs. 3.16 ± 0.93 minutes, P < 0.001) and shorter motor block duration (137.72 ± 11.51 vs. 149.09 ± 14.44 minutes, P = 0.006), with no significant difference in the sensory block duration and motor block onset.ConclusionAddict patients have delayed onset of sensory block with shorter duration of motor block and lower sensory block level. Among the blood gas and CSF markers, only pH was significantly higher in addict patients, needing further evaluations; however, it seems that addiction has no significant effect on these parameters.

Intrathecal ropivacaine vs bupivacaine in endoscopic urological surgeries: a double blind randomized controlled trial

Aims: To compare sensory, motor effects and haemodynamic stability of 2ml intrathecal isobaric ropivacaine (0.75%) with 3ml hyperbaric bupivacaine (0.75%) in patients undergoing endoscopic urological surgery. Study Design: Randomized controlled trial involving 142 patients undergoing transurethral resection of prostate (TURP) and URS (urethroscopy) in a tertiary care hospital, India. Methods and materials: Patients were randomly allocated to, Group 1 (3ml of 0.5% (15mg) hyperbaric bupivacaine) and Group 2 (2ml of 0.75% isobaric ropivacaine(15mg)). Onset and highest level of sensory block, onset and duration of motor block, quality of anaesthesia and muscle relaxation, haemodynamic parameters and adverse effects if any were studied. Statistical analysis used: Unpaired t-test was used to test continuous variables and chi square test/Fisher’s exact test for categorical variables. Results: The mean of highest sensory block, 2 segment regression of sensory block and time for sensory level to regress below T10 was significantly more in group 1 compared to group 2 (P Conclusion: Ropivacaine provides comparable quality of sensory block but has slower onset and significantly shorter duration of motor block compared to hyperbaric bupivacaine.

Antinociceptive Effect of Liposomal Bupivacaine Formulations After Intrathecal Administration in Rats

Background/aimBased on our previous in vitro study with multilamellar liposomal bupivacaine (MLB) versus bupivacaine alone in artificial cerebrospinal fluid, we aimed to investigate in vivo antinociceptive effect of intrathecal MLB by determining tail flick latency (TFL) time after thermal stimulation in rats. Materials and methodsAfter preparing MLB and high-yield drug entrapment in liposome (HYDEL) bupivacaine, 18 female Wistar rats were assigned to 3 groups as control (bupivacaine) and study groups (MLB and HYDEL bupivacaine) including 6 rats in each group to administer these drugs intrathecally. Antinociceptive activity was determined in terms of TFL time after thermal stimulation. Maximum possible effect (MPE) calculated from TFL times and rats with motor block were documented. Results TFL times after intrathecal injection of HYDEL bupivacaine were significantly longer than that of the control and MLB groups (P < 0.05) and returned to baseline 180 min after intrathecal injection. MPE (100%) with intrathecal HYDEL bupivacaine occurred between 10 to 45 min. Afterwards, MPEs were 70% and 50% for the control and MLB groups, respectively. Motor block disappeared after 20 min in the study groups while it lasted 75 min in the control.ConclusionIntrathecal administration of MLB and HYDEL bupivacaine in rats resulted in longer duration of antinociceptive activity with shorter motor block duration.

A comparative study between the effect of intrathecal hyperbaric bupivacaine with fentanyl and hyperbaric levobupivacaine with fentanyl for knee arthroscopy

Background The use of levobupivacaine as a pure S (−) enantiomer of bupivacaine was progressively increased due to lower cardiotoxicity and neurotoxicity and shorter motor block duration. The aim of this work was to compare the effectiveness of lower-dose local anesthetics’ use together with higher opioid dose to decrease the side effects of drugs. We compared sensorial, motor block levels and side effects of equal doses of hyperbaric bupivacaine and levobupivacaine with intrathecal fentanyl addition in knee arthroscopy. Patients and methods After hospital ethics committee approval and getting written informed consent from patients, 100 patients with American Society of Anesthesiologists grade I–II, aged 18–40 years were included in the study. They were randomized to either group A receiving 7.5 mg (1.5 ml) hyperbaric levobupivacaine with 25 μg (0.5 ml) fentanyl, or group B receiving 7.5 mg (1.5 ml) hyperbaric bupivacaine with 25 μg (0.5 ml) fentanyl. Results Hemodynamic parameters such as the 45th minute mean arterial pressure of group B was found to be lower (P&lt;0.05). In group A, maximum sensorial block level and postoperative visual analog scale scores were higher (P&lt;0.05). Onset of motor block time, time to maximum motor block, time to sensorial block, reversal of two dermatome and first analgesic need were similar in both groups. Conclusion Intrathecal hyperbaric levobupivacaine–fentanyl combination is a better and good alternative to bupivacaine–fentanyl combination in knee arthroscopy, as it maintains hemodynamic stability.

Duration of Motor Block With Intrathecal Ropivacaine Versus Bupivacaine for Cesarean Section: A Meta-analysis

(Int J Obstet Anesth. 2016;27:9–16) Bupivacaine is a local anesthetic commonly used for spinal anesthesia. It provides a quick onset and sustained duration of sensory block but its prolonged duration of motor block is sometimes considered a disadvantage of the drug. Ropivacaine is another local anesthetic that has been used for spinal anesthesia. It is considered to have a shorter duration of motor block. This current meta-analysis was undertaken to examine the difference in duration of motor block as well as several secondary outcomes when ropivacaine was used compared with bupivacaine for spinal anesthesia for cesarean section.

Comparison of 0.5% Bupivacaine and 0.5% Ropivacaine epidurally in lower limb orthopaedic surgeries

Background: Ropivacaine in equi-potent concentrations with bupivacaine, the degree of motor blockade is less pronounced with ropivacaine, and there is a greater propensity for blocking pain transmitting A-delta and C fibres rather than A-α motor fibres. It appears to have most of the blocking characteristics of bupivacaine. So we have undertaken the study to compare ropivacaine 0.5% (20ml) and bupivacaine 0.5% (20ml) for epidural anaesthesia in patients undergoing lower limb orthopaedic surgeries.Methods: This double-blind, randomized study involves 60 patients who were undergone orthopaedic surgery, having ASA-I or ASA-II physical status. Out of 60, 30 patients received 20 ml of 0.5% ropivacaine and 30 patients received 20 ml of 0.5% bupivacaine at the L3, 4 interspace. Parameters measured were the onset time, duration and spread of sensory block, the onset time, peak time, duration and degree of motor block, the quality of anaesthesia and the heart rate and blood pressure profile during block onset.Results: Epidurally, Ropivacaine in comparison to Bupivacaine provides quicker onset, early peak effect and prolonged duration of sensory block and shorter duration of motor block. Ropivacaine provides prolonged effective analgesia. It reduces requirement of rescue analgesics and related side effects.Conclusions: Ropivacaine 0.5% is safer and effective alternative to Bupivacaine in epidural anaesthesia and post operative pain relief.

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.

English

INTRODUCTION: Spinal Anaesthesia is the widely used method for lower limb orthopaedic surgeries, providing a faster onset and effective motor and sensory blockade. It is simple, easy to perform and has got a definite endpoint. Intrathecal bupivacaine is widely used in spinal anaesthesia over a long period of time. In this setting, a newer drug Ropivacaine has emerged, which is being widely used for epidural blocks and nerve plexus blocks. Ropivacaine has an improved safety profile over bupivacaine with respect to central nervous system and cardio toxic potential. Though ropivacaine is being used frequently, in epidural and nerve blocks, the literature regarding its use in intrathecal route is sparse. AIM OF THE STUDY: Intrathecal bupivacaine results in a longer duration of complete anaesthetic block than ropivacaine. Fentanyl used as an adjuvant may improve the quality of spinal block of ropivacaine, while maintaining its advantage of early motor recovery. The aim of the study was to compare the efficacy and safety of intrathecal ropivacaine‑fentanyl (RF) with bupivacaine‑fentanyl (BF) for lower limb orthopaedic surgeries. METHODS: In this Single Centered, Prospective, Randomized, Parallel group, Double – Blind study, sixty patients were randomly allocated to receive either intrathecal 15 mg of 0.5% ropivacaine with 25 mcg fentanyl (Group RF) or 15 mg of 0.5% bupivacaine with 25 mcg fentanyl (Group BF). The onset, duration, spread of sensory and motor block, haemodynamic parameters and side effects were recorded. Data analysis was done by using SPSS software and Sigma Stat 3.5 version (2012). RESULTS: Time to reach highest sensory level, complete motor block and two segment sensory regression time were comparable. The motor recovery to Bromage scale 1 was faster in Group RF. The haemodynamic stability was better in Group RF. Time duration of analgesia was prolonged in Group BF. CONCLUSION: Intrathecal RF provided satisfactory anaesthesia with Haemodynamic stability for lower limb orthopaedic surgeries. It provided a similar sensory but a shorter duration of motor block compared to BF, which is a desirable feature for early ambulation, voiding and physiotherapy.

Addition of magnesium sulphate to ropivacaine for spinal analgesia in dogs undergoing tibial plateau levelling osteotomy

The aim of this blinded, randomised, prospective clinical trial was to determine whether the addition of magnesium sulphate to spinally-administered ropivacaine would improve peri-operative analgesia without impairing motor function in dogs undergoing orthopaedic surgery. Twenty client-owned dogs undergoing tibial plateau levelling osteotomy were randomly assigned to one of two treatment groups: group C (control, receiving hyperbaric ropivacaine by the spinal route) or group M (magnesium, receiving a hyperbaric combination of magnesium sulphate and ropivacaine by the spinal route). During surgery, changes in physiological variables above baseline were used to evaluate nociception. Arterial blood was collected before and after spinal injection, at four time points, to monitor plasma magnesium concentrations. Post-operatively, pain was assessed with a modified Sammarco pain score, a Glasgow pain scale and a visual analogue scale, while motor function was evaluated with a modified Tarlov scale. Assessments were performed at recovery and 1, 2 and 3 h thereafter. Fentanyl and buprenorphine were administered as rescue analgesics in the intra- and post-operative periods, respectively.Plasma magnesium concentrations did not increase after spinal injection compared to baseline. Group M required less intra-operative fentanyl, had lower Glasgow pain scores and experienced analgesia of longer duration than group C (527.0 ± 341.0 min vs. 176.0 ± 109.0 min). However, in group M the motor block was significantly longer, which limits the usefulness of magnesium for spinal analgesia at the investigated dose. Further research is needed to determine a clinically effective dose with shorter duration of motor block for magnesium used as an additive to spinal analgesic agents.

Comparative evaluation of hyperbaric ropivacaine with hyperbaric bupivacaine for spinal anesthesia in elective gynecological surgeries

Background Hyperbaric ropivacaine provides adequate sensory and motor block for short duration surgical procedures, safe hemodynamic profile, rapid recovery, early ambulation, and less side effects. Aim and objective The aim of this study was to evaluate the clinical efficacy and safety of subarachnoid block with 0.5% hyperbaric ropivacaine compared with 0.5% hyperbaric bupivacaine in elective gynecological surgeries. Methods Fifty female patients of ASA physical status I and II were randomly selected and divided into two groups: group R and group B. Group R was given 3 ml of 0.5% hyperbaric ropivacaine (15 mg) and group B was given 3 ml of 0.5% hyperbaric bupivacaine (15 mg) during subarachnoid block. Preoperative and intraoperative hemodynamic variables such as heart rate, blood pressure, and SpO 2 were recorded. Sensory and motor block were also assessed at regular intervals. Results The mean time to achieve the highest level of sensory block was 13.1 min in group R and 12.2 min in group B ( P P P P Conclusion Hyperbaric ropivacaine has lower level of cephalad spread of sensory block, takes more time for maximum spread of analgesia, has early regression of sensory block to L5, has longer onset time for motor block, shorter duration of motor block, and causes less hypotension and other side effects compared with hyperbaric bupivacaine.

A randomized clinical study comparing spinal anesthesia with isobaric levobupivacaine with fentanyl and hyperbaric bupivacaine with fentanyl in elective cesarean sections.

Background:To date, racemic bupivacaine is the most popular local anesthetic for spinal anesthesia in parturients undergoing elective cesarean delivery. With the introduction of levobupivacaine as pure S (–) enantiomer of bupivacaine which offers advantages of lower cardiotoxicity and neurotoxicity and shorter motor block duration, its use has widely increased in India. However, very few studies have been conducted about its efficacy in obstetric anesthesia. Thus, this study was undertaken to compare the sensorial, motor block levels, and side-effects of equal doses of hyperbaric bupivacaine and levobupivacaine with intrathecal fentanyl addition in elective cesarean cases.Materials and Methods:After approval of College Ethical Committee, 30 parturient with American Society of Anesthesiologists I-II undergoing elective cesarean section were enrolled for study with their informed consent. They were randomly divided equally to either Group BF receiving 10 mg (2 ml) hyperbaric bupivacaine and 25 mcg (0.5 ml) fentanyl, or Group LF receiving 10 mg (2 ml) isobaric levobupivacaine and 25 mcg (0.5 ml) fentanyl. Sensory and motor block characteristics of the groups were assessed with pinprick, cold swab, and Bromage scale; observed hemodynamic changes and side-effects were recorded. Effects on the neonate were observed by APGAR score at 1 and 5 min and umbilical cord blood gas analysis.Results:Hemodynamic parameters like mean arterial pressure of Group BF were found to be lower. Group BF exhibited maximum motor block level whereas in Group LF, max sensorial block level and postoperative visual analog scale scores were higher. Umbilical blood gas pCO2 was slightly higher, and pO2 was marginally lower in Group BF. Onset of motor block time, time to max motor block, time to T10 sensorial block, reversal of two dermatome, the first analgesic need were similar in both groups.Conclusion:Intrathecal isobaric levobupivacaine-fentanyl combination is a good alternative to hyperbaric bupivacaine-fentanyl combination in cesarean surgery as it is less effective in motor block, it maintains hemodynamic stability at higher sensorial block levels.

Comparison of intrathecal ropivacaine-fentanyl and bupivacaine-fentanyl for major lower limb orthopaedic surgery: A randomised double-blind study.

Background and Aims:Intrathecal bupivacaine results in complete anaesthetic block of longer duration than ropivacaine. Fentanyl as an adjuvant may improve the quality of spinal block of ropivacaine while maintaining its advantage of early motor recovery. In this study, we proposed to compare the efficacy and safety of intrathecal ropivacaine-fentanyl (RF) with bupivacaine-fentanyl (BF) for major lower limb orthopaedic surgeries.Methods:Sixty patients were randomly allocated to receive either intrathecal 15 mg 0.5% ropivacaine with 25 mcg fentanyl (Group RF) or 15 mg 0.5% bupivacaine with 25 mcg fentanyl (Group BF). The onset, duration, spread of sensory and motor block, haemodynamic parameters and side effects were recorded. Statistical Package for Social Sciences 20 software was used for statistical analysis.Results:Time to reach highest sensory level and complete motor block were comparable. Sensory regression to L1 dermatome was 226 ± 46.98 min in Group RF and 229.33 ± 50.51 min in Group BF, P = 0.36. The motor recovery to Bromage scale 1 was faster in Group RF (242.8 ± 47.06 min) than Group BF (268 ± 49.9 min) P = 0.023. Time for rescue analgesia was prolonged in Group BF (263.33 ± 63 min) when compared to Group RF (234.44 ± 58.76 min), P = 0.021. The haemodynamic stability was better in Group RF than Group BF.Conclusion:Intrathecal RF provided satisfactory anaesthesia with haemodynamic stability for major lower limb orthopaedic surgery. It provided similar sensory but shorter duration of motor block compared to BF which is a desirable feature for early ambulation, voiding and physiotherapy.

Comparison of intrathecal hyperbaric bupivacaine and levobupivacaine with fentanyl for caesarean section

Background: Use of levobupivacaine as pure S(-) enantiomer of bupivacaine is progressively increased due to lower cardiotoxicity and neurotoxicity and shorter motor block duration.. The aim was to compare the efficacy of lower dose local anesthetics use together with higher opioid dose to decrease side effects of drugs. We compared sensorial, motor block levels and side effects of equal doses of hyperbaric bupivacaine and levobupivacaine with intrathecal fentanyl addition in elective caesarean cases.

Comparison of Equipotent Doses of Ropivacaine-fentanyl and Bupivacaine-fentanyl in Spinal Anaesthesia for Lower Abdominal Surgery

The aim of this randomised, double-blind study was to compare equipotent doses of plain ropivacaine and bupivacaine (19.5 mg and 13 mg respectively), both with fentanyl 20 microg, for spinal anaesthesia in lower abdominal surgery. After written informed consent had been obtained, 52 ASA I to II male patients scheduled for lower abdominal surgery were randomly assigned to receive intrathecal plain ropivacaine 19.5 mg with fentanyl 20 microg (group R, n =26) or plain bupivacaine 13 mg with fentanyl 20 microg (group B, n =26) in 3 ml. The level and duration of sensory block, intensity and duration of motor block, time to mobilise and patient satisfaction were recorded. All patients achieved sensory block to T10 or higher The level of sensory block was significantly higher in group B (T4 [T3 to T7] vs T7 [T4 to T9], P <0.05). There was no difference in the onset time of motor block. The duration of motor block (Bromage score >0) was shorter in group R (139+/-39 minutes vs group B 182+/-46 minutes, P <0.05). The duration and intensity of complete motor block (Bromage score=3) were also shorter in group R (90+/-25 minutes vs 130+/-40 minutes, P <0.05). We conclude that plain ropivacaine 19.5 mg plus fentanyl 20 microg is associated with a lower level of sensory block and a shorter duration of motor block when compared to bupivacaine 13 mg plus fentanyl 20 microg for spinal anaesthesia in lower abdominal surgery.