Background: Subarachoid Block (SAB) has been practicing as pediatric anesthesia from the very begining but still not popular in Bangladesh. There are all lots of fallacies regarding efficacy and safety of SAB in pediatric age guoup. Current study was carried out to assess the efficacy and safety of SAB among children of 8-14 years. Materials & methods: This retrospective observational study was conducted in M A Rashid Hospital, Jamalpur from May 2023 to October 2023 by analyzing data of 32 patients (8-14 years) of ASA grading I who underwent different lower andominal and lower extremity surgeries under SAB. All the patients were evaluated following standard protocol in pre anesthetic checkup room Children were sedated with Inj. Ketamine 10 mg I/V along with Inj. Midazolam 1mg I/V. SAB was given with 25G spinocaine needle at the level of L4/L5 with 0.5% Bupivacaine hyperbaric 1.5 ml (7.5 mg) following local anesthetic (lidocaine 1% 1 ml) infiltration at the site of SAB in left lateral position. Demographic characteristics, type of surgery, duration of surgery, outcome of SAB, perioperative vital parameters (Pulse rate, systolic blood pressure, diastolic blood pressure, SPO2, ECG) characteristics of sensory and motor block, duration upto first pain complain and complication were recorded as study data by analyzing anesthesia documents and postoperative records. Results: Mean age of the study population was 10.00 ± 2.02 years, 53.13% patients were male and all the patients were from ASA grading I. Mean operative time for surgeries was 33.59± 11.23 minutes. Circumcision (40.63%) was the commonest procedure. Success rate of SAB was 100%. Onset and duration of sensory block was 5± 2.0 minutes and 120.23± 12.34 minutes respectively. Onset of motor block could not be assessed as patients were sedated. And duration of motor block was 112.19± 12.76 minutes.Time duration for first complain of pain was 150.31± 14.64 minutes. Vital parameters of studied population were stable in perioperative period. There was not a single incidence of complication like nausea, vomiting, itching, chest pain, restlessness, shivering, urinary retention, neurological complications, Post Dural Puncture Headache (PDPH). Conclusion: Subarachnoid block could be an effective and safe alternative for the anesthetic management of pediatric patients while performed by experienced anesthesiologist. Journal of Brahmanbaria Med. Coll. Volume 07 Issue 01 Jan 2025 ; 25-29

Background: Subarachnoid block-induced hypotension and bradycardia remain a frequent andclinically significant complications during cesarean section. Strategies such as fluid co-loading and ondansetron have been employed to mitigate these effects, but their comparative effectiveness remains under investigation.Objective: To compare the effectiveness of 8 mg IV ondansetron versus 500 mL crystalloid co‐loading in reducing subarachnoid block-induced hypotension and bradycardia.Methods: A prospective randomized comparative study carried out in the Gynecology andObstetrics Hospital, Imam Al-Hassan Al-Mujtaba Teaching Hospital, Gynecology and ObstetricsDepartment, Karbala, Iraq from October 2024 to March 2025. A total of 180 women wereassessed for eligibility, and only 172 were included and allocated into three groups: the co-loading group (57 women) received 500 mL saline solution 0.9% IV starting rapidly with intrathecal injection of local anesthesia; the ondansetron group (58 women) received 8 mg of ondansetron IV and both intervention groups (co-loading and ondansetron) received preloading ~10-mL/kg saline solution 0.9% IV; and the control group (57 women) received only preloading ~10-mL/kg saline solution 0.9% IV.Results: Ondansetron reduced the overall hypotension from 73.7% (control) to 55.2% (P = 0.038) and vasopressor dose from 18.7±12.9 mg to 8.5±9.8 mg (P < 0.001). Co-loading did not significantly reduce the overall hypotension (64.9%, P = 0.31). Bradycardia incidence was low and similar across groups (P = 0.233). Ondansetron also reduced nausea/vomiting (P = 0.007) and shivering (P = 0.019).Conclusion: Ondansetron demonstrated superior effectiveness in reducing subarachnoid block-induced hypotension, vasopressor use, intraoperative nausea/vomiting, and shivering, compared to crystalloid co-loading.

Background: Hypotension frequently occurs with subarachnoid block (SAB) due to sympathetic blockade. Ephedrine is used to maintain blood pressure, but requires caution due to possible adverse effects. This study aims to evaluate the efficacy and safety of prophylactic intravenous ephedrine in preventing hypotension in patients undergoing surgery under SAB. Methods: This prospective, randomized controlled trial was conducted at the Department of Anesthesiology, Gazi Medical College and Hospital, Khulna, Bangladesh. A total of 200 patients undergoing elective surgeries under SAB were randomly assigned to one of two groups using an odd-even method to either the prophylactic Ephedrine Group (n=100) or the Control Group (n=100). Hemodynamic parameters were monitored at multiple intervals. Primary and secondary outcomes included hypotension incidence, additional vasopressor use, and adverse effects. Statistical analyses were performed using SPSS version 26, with p<0.05 considered significant. Results: Baseline characteristics, including age, BMI, and ASA grade, were comparable between groups. The Ephedrine group demonstrated significantly higher SBP and DBP at 5, 10, and 15 minutes post-SAB (p<0.001). MAP was significantly better maintained in the Ephedrine group at all measured intervals (p<0.001 at 5–15 minutes). The incidence of hypotension was significantly lower in the Ephedrine group (9%) compared to the Control (44%, p<0.001). Fewer patients in the Ephedrine group required additional vasoconstrictors (5% vs. 15%, p=0.021). There was no significant difference in HR or SpO₂ between groups. The Ephedrine group had a shorter mean discharge time (48.6 ± 10.5 vs. 53.2 ± 12.3 min, p=0.038). No significant adverse events related to ephedrine were observed. Conclusion: Prophylactic ephedrine prevents hypotension during subarachnoid block, ensuring hemodynamic stability with minimal side effects. Patients receiving prophylactic ephedrine required fewer additional vasoconstrictors and had shorter shifting times. Mediscope 2026;13(1): 34-40

Background: Maternal hypotension often occurs during spinal anesthesia for cesarean delivery and can be risky for both mother and fetus. Crystalloids are commonly used to prevent this, but it remains unclear whether giving them before anesthesia (preload) or during anesthesia (coload) is more effective. This study compares the effectiveness of preload versus coload crystalloid administration for preventing hypotension during spinal anesthesia for cesarean sections. Methods: This prospective, controlled clinical trial was conducted at Gazi Medical College, Khulna, Bangladesh, from July 2024 to December 2024. The study enrolled a total of 200 ASA Grade I-III parturients undergoing elective cesarean delivery under spinal anesthesia. Participants were randomly divided into two groups: preload (n=100) and coload (n=100) using an odd-even method based on the enrollment sequence. Intravenous crystalloids were administered before or immediately after spinal anesthesia, respectively. Standard monitoring and spinal anesthesia procedures were followed. Statistical analysis was performed using SPSS v26.0, and a p-value <0.05 was considered statistically significant. Results: Some baseline characteristics showed statistical differences but were not considered clinically meaningful. Hemodynamic parameters were monitored at several intervals post-spinal anesthesia. Heart rate initially increased, peaking at 5 minutes, then gradually declined. The maximum SBP drop at 5 minutes was significantly greater in the preload group (p <0.001). DBP also decreased notably at 10 minutes (p <0.001). MAP was significantly higher in the coload group at 10 minutes (p <0.001). Hypotension occurred less frequently in the coload group (57% vs. 86%, p <0.001), indicating greater coloading effectiveness in preventing hypotension during cesarean section under subarachnoid block (SAB). Conclusion: Coloading with crystalloids during spinal anesthesia (SAB) for cesarean sections is a more effective approach than preloading in preventing maternal hypotension, particularly in resource-limited settings. Due to its simplicity and practicality, coloading is a cost-effective strategy for managing anesthesia in obstetric care. Mediscope 2026;13(1): 01-07

Introduction: Effective postoperative pain management is vital for patient recovery and comfort. Due to the side effects associated with opioids, alternative strategies such as Pregabalin are being explored. As a Gamma-aminobutyric Acid (GABA) analogue, Pregabalin may reduce pain and analgesic requirements by modulating central sensitisation. The present study evaluates the impact of preoperative oral Pregabalin on enhancing subarachnoid block, prolonging postoperative analgesia and improving recovery in patients undergoing neuraxial surgeries. Aim: To evaluate the efficacy of oral Pregabalin (150 mg and 300 mg) compared with a placebo in reducing postoperative pain in patients undergoing surgical procedures under spinal anaesthesia. Materials and Methods: The present double-blinded randomised controlled trial was conducted in the Department of Anaesthesiology at SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu, India, from September 2024 to February 2025 over a duration of six months. After obtaining written consent, 90 patients undergoing surgery under neuraxial blockade were recruited and randomised into three groups. The study drugs were administered one hour before surgery as follows: Group C (Placebo drug), Group P1 (T. Pregabalin 150 mg), Group P2 (T. Pregabalin 300 mg). The Ramsay Sedation Scale was used to assess sedation levels before and after the procedure. Pain intensity was assessed using the Visual Analogue Scale (VAS). Statistical analysis was performed using Statistical Packages of Social Sciences (SPSS) software (version 26.0), with a significance level set at 0.05. Results: There was no statistically significant difference in the demographic characteristics of the study participants, such as age, height and weight (Mean=40.01 years, 166.42 cm, 67.3 kg; p=0.537, 0.454, 0.349, respectively). The time to first analgesic requirement after spinal anaesthesia was significantly longer in patients who received pregabalin compared with those who received the placebo (Mean=105.83, 120.33, 126.67 minutes, respectively; p<0.001). Corresponding VAS scores at the time analgesia was administered were also statistically significant (Mean=4.04, 3.08, 2.99, respectively; p<0.001). Conclusion: Compared with placebo, preoperative oral pregabalin was effective in enhancing sedation, delaying the onset of postoperative pain and reducing the need for early rescue analgesics.

Background: Subarachnoid block is often the choice of anaesthesia for lower limb surgeries. Hyperbaric Ropivacaine, a newer commercially available local anaesthetic preparation, offers faster recovery and fewer cardiovascular effects than bupivacaine but has a shorter duration of action. To prolong anaesthesia and postoperative analgesia, opioids such as fentanyl and buprenor-phine are used as adjuvants to local anaesthetics.Aim: This study aimed to compare the efficacy and safety of intrathecal buprenorphine versus fen-tanyl as adjuvants to hyperbaric ropivacaine in lower limb surgeries.Material and Methods: A prospective, double-blinded, randomised controlled trial was carried out in 76 patients, aged 18–60 years, belonging to ASA I and II and scheduled for lower limb pro-cedures under subarachnoid block. Patients were randomly allocated into two groups: Group B was given 3 ml of 0.75% hyperbaric ropivacaine with 0.5 ml buprenorphine (150 mg), while Group F got the same dose of ropivacaine with 0.5 ml fentanyl (25 mg). Parameters assessed included onset,level, sensory and motor block duration, changes in the haemodynamics, postoperative analgesia, and side effects.Results: Group F showed a significantly faster onset (p=<0.001) and time to reach maximum sensory level (p=<0.001). However, Group B had a significantly prolonged duration of sensory block and analgesia (p=<0.001). Group B demonstrated better haemodynamic stability, with fewer episodes of hypotension and bradycardia, though not statistically significant. Onset of motor block was faster, but duration was shorter in Group B. Minor side effects like pruritus and urinary reten-tion were more frequent in Group B.Conclusion: Buprenorphine as an intrathecal adjuvant to hyperbaric ropivacaine provides superior postoperative analgesia, prolonged sensory block, and better hemodynamic stability than fentanyl, making it a preferable choice for lower limb surgeries.

Hyperbaric ropivacaine has been recently introduced commercially in India. Hyperbaric bupivacaine is the most commonly used local anesthetic drug in subarachnoid blocks. We conducted this meta-analysis to compare the onset and duration of sensory and motor blockade and complications of the two drugs. We searched Cochrane, PubMed, and Google Scholar databases till February 9, 2022, for randomized control trials comparing hyperbaric ropivacaine and hyperbaric bupivacaine in subarachnoid blocks without adjuvant. Studies comparing bupivacaine and ropivacaine with any other local anesthetic were not included. Study selection was done, and data were extracted. Individual study quality was assessed using the Cochrane risk of bias assessment tool. Methodological quality was assessed using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) guidelines. Trial sequential analysis was done to check if the sample size is adequate and if the conclusions are reliable or not. The primary outcome analyzed was duration of motor blockade, and secondary outcomes were duration of sensory blockade, onset of sensory and motor blockade, and complications such as hypotension, bradycardia, nausea, and shivering. After doing an extensive search, we found 18 studies as per our inclusion criteria. The duration of motor blockade (37.09, 26.93-47.24, P < 0.00001) and sensory (38.83, 24.97-52.69, P < 0.00001) was found to be significantly short in the ropivacaine group. Hypotension (P = 0.0004) and bradycardia (P = 0.02) were also found to be less in the ropivacaine group. Hyperbaric ropivacaine has shorter duration of sensory and motor block and therefore a faster recovery as compared to hyperbaric bupivacaine.

Background: Proper pain control before subarachnoid block (SAB) is must in proximal femur fractures as patients cannot tolerate movement due to severe pain. This study compares ultrasound-guided fascia iliaca compartment block (USG-FICB) with femoral nerve block (USG-FNB) for pre-SAB analgesia. Materials and Methods: Ninety patients scheduled for elective femur fracture surgery under SAB were randomly divided. Group FICB received 25 ml of 0.25% bupivacaine and Group FNB got 15 ml. Pain was assessed using Numerical Rating Scale (NRS) scale. Time for first rescue dose, side effects, and patient satisfaction also noted. Results: Both groups had similar baseline NRS. Group FICB showed faster pain relief and better positioning comfort during SAB (NRS 3.00 vs. 4.28 P = 0.001). Time to first rescue analgesia was more in FICB (4.67 vs. 2.71 h P = 0.001). Satisfaction scores were also higher. Hemodynamics stayed stable, and adverse events were rare. Conclusion: USG-FICB is more effective than USG-FNB in controlling pain before SAB in femur fracture surgery.

Subarachnoid block (SAB) is a preferred anesthetic technique for infraumbilical surgeries. However, in obese patients, landmark identification for SAB can be difficult, increasing the risk of procedural failure and complications. This study is determined to compare the efficacy of ultrasound (USG)-guided, C-arm fluoroscopy-guided, and anatomical landmark-guided SAB in obese patients. Sixty patients of 18-80 years with BMI ≥30 kg/m² of American Society of Anaesthesiologist Physical Status (ASA PS) II-III scheduled for infraumbilical surgeries were randomized into three equal groups: Group A, Group B, and Group C for USG-guided, C-arm-guided, and Landmark-guided SAB, respectively. Each received 0.5% hyperbaric bupivacaine intrathecally using a 25-G Quincke's needle. Total time taken for the procedure, number of spinal needle insertion attempts, patient satisfaction score, success rate, and complications in each group were recorded. All groups were comparable demographically. Group B had the significantly highest total time taken for the procedure, 380.4 ± 46.2 seconds, compared to Group A, 273.6 ± 7.5 seconds, and Group C, 165.7 ± 23.2 seconds. The number of spinal needle insertion attempts was lowest in Groups A and B, with higher patient satisfaction scores. Complications occurred only in Group C. Imaging modalities-guided SAB in obese patients took a prolonged procedure time but had fewer spinal needle insertion attempts and better patient satisfaction than the landmark-guided SAB. Between the imaging modalities, USG-guided SAB was faster, required fewer needle insertions, and gave better patient satisfaction than C-arm guided SAB.

BACKGROUND Correct placement of the spinal needle is crucial for spinal anesthesia. Due to physiological changes associated with pregnancy like weight gain and changes in the curvature of spine, performing spinal anesthesia may be difficult leading to multiple attempts, inadvertent nerve injuries and patient discomfort. So a pre-procedural estimation of the skin to subarachnoid space depth may be beneficial. This study aims to estimate the skin to subarachnoid space depth by using Ultrasound in pregnant females undergoing cesarean section under spinal anesthesia. METHODS This was a prospective, observational study conducted at a district hospital of Nepal in parturients undergoing cesarean section under spinal anesthesia. A pre-procedural ultrasound of lumbo-sacral spine was done by using 2-5 Hz curvilinear probe and skin to subarachnoid space depth (SSD) was measured at the level of L3-L4 using inbuilt calipers after which subarachnoid block was performed under all aseptic precautions. RESULTS Total patients included in the study were 50 pregnant females with mean age being 24.5 (± 8.56). The ultrasound estimated SSD was found to be 4.24 ± 0.48 cm. CONCLUSIONS Ultrasound estimated SSD in the study population was found to be 4.24 ± 0.48 cm which is almost same as the inserted length of spinal needle. So, use of ultrasound can be very helpful in performing subarachnoid block.

Background: Globally, the incidence of hypotension has been very high during cesarean section under spinal anesthesia. Hence, to manage hypotension and maintain adequate blood pressure, vasopressors such as Phenylephrine, Mephentermine, and Ephedrine are commonly used. Materials and Methods: A Prospective Randomized Double-blind study was conducted among 102 singleton pregnant women undergoing cesarean section at Nobel Medical College Teaching Hospital Ltd. Following hypotension, group P received Phenylephrine 100 mcg IV, Group E received Ephedrine 6 mg IV and group M received Mephentermine 6 mg IV. Vital parameters like blood pressure (systolic, diastolic and mean), heart rate, and oxygen saturation were recorded preoperatively as well as intraoperatively. Results: After administering vasopressors, Group P showed a significantly greater increase in blood pressure than Groups E and M at the 4-, 6-, 8-, and 10-minute intervals. However, Group P also demonstrated a significant decrease in heart rate at 4, 6, 16, 18, 20, and 30 minutes compared with Groups E and M. Drug bolus requirements and maternal side effects were similar among groups. Neonatal outcomes were comparable, with Apgar scores &gt;7 in all cases. Conclusion: From our study, it can be concluded that all three vasopressors Phenylephrine, Ephedrine, and Mephentermine were able to restore hypotension during cesarean section, although Phenylephrine achieved faster blood pressure control, though it was associated with a reduction in heart rate. Therefore, phenylephrine is most suitable when rapid blood pressure control is required, provided that heart rate is closely monitored.

Introduction: Spinal anesthesia-induced hypotension is a pervasive physiological challenge during cesarean delivery, precipitating maternal hemodynamic instability and compromising uteroplacental perfusion. While phenylephrine and ephedrine are the mainstay vasopressors for prophylaxis, their comparative impact on immediate neonatal vitality in the context of bolus administration remains a critical subject of investigation, particularly in resource-limited settings where infusion pumps are not universally available. This study aimed to rigorously compare the efficacy of prophylactic intravenous bolus phenylephrine versus ephedrine regarding maternal blood pressure control and neonatal APGAR scores. Methods: We conducted a prospective, randomized, double-blind experimental study at Dr. Saiful Anwar Regional General Hospital, Malang. Forty-two parturients classified as ASA I or II undergoing elective cesarean section were randomized into two groups. Immediately following subarachnoid block, Group P received a bolus of Phenylephrine (125 µg), and Group E received Ephedrine (10 mg). Hemodynamic parameters were recorded at baseline and at 1, 3, 6, 9, 12, 15, and 18 minutes post-anesthesia. The primary outcome was the neonatal APGAR score at the first minute. Results: Both vasopressor regimens successfully mitigated severe spinal-induced hypotension. There were no statistically significant differences in the magnitude of systolic or diastolic blood pressure reduction between the Phenylephrine and Ephedrine groups at any observed time point (p&gt;0.05). However, a significant divergence was observed in neonatal outcomes. The mean first-minute APGAR score in the Phenylephrine group was significantly higher (7.62 ± 0.97) compared to the Ephedrine group (7.05 ± 0.74) with a p-value of 0.038. Conclusion: Phenylephrine and ephedrine demonstrated equipotent efficacy in maintaining maternal hemodynamic stability when administered as prophylactic boluses. However, phenylephrine prophylaxis resulted in superior immediate neonatal vitality as evidenced by significantly higher first-minute APGAR scores. Phenylephrine should be prioritized as the vasopressor of choice to optimize neonatal safety during cesarean delivery.

A 72-year-old female patient weighing 80 kg underwent right total knee replacement (TKR) under successful subarachnoid block (SAB) and continuous femoral nerve block (cFNB). Five days later, SAB failed twice for left TKR, with no sensorimotor block observed. The patient refused general anaesthesia on the first day but underwent surgery under general anaesthesia the next day. Postoperative analgesia via ultrasound-guided cFNB was inadequate. This unusual sequence of events, involving differential success of SAB and nerve blocks during two surgeries with different drugs and techniques, suggests acquired acute resistance to local anaesthetics. While technical failure is a common cause of SAB failure, genetic variations in sodium channels, potentially acquired over time, may explain this phenomenon. Such resistance is rare and challenging to diagnose, highlighting the need for further investigation into molecular mechanisms and genetic testing in similar cases.

Background Subarachnoid block is the most widely used technique for lower limb surgeries because of its cost-effectiveness, good muscle relaxation, reliability, prolonged analgesia and early ambulation. Clonidine as an adjuvant for subarachnoid block may improve analgesia. So, in this study, we propose to evaluate the analgesic efficacy of hyperbaric levobupivacaine with or without clonidine in patients undergoing surgery for femoral fractures. Secondarily, we also compared sensory and motor block characteristics and noted side effects. Methods Subarachnoid block was given in sitting position under all aseptic precautions at the level of L2-L3or L3-L4intervertebral space as per the standard protocol. Intrathecal drug was given according to the group allotted as follows: Group-LC: 15 mg of 0.5%hyperbaric levobupivacaine (3 ml) + 15 mcg of clonidine (0.1 ml); Group-LN: 15 mg of 0.5% hyperbaric levobupivacaine (3 ml) + normal saline (0.1 ml) The total volume of intrathecal drug was 3.1 ml in both groups. Block characteristics were assessed using loss of pinprick sensation for sensory block and Modified Bromage Scale (MBS) for motor block. Hemodynamic variables were also recorded. Results The demographic profiles of both groups were comparable to each other with respect to gender, American Society of Anesthesiologists (ASA) grade, weight and height of patients. The duration of effective analgesia was 166.67 ±31.72min in group LC and98.80 ±8.99 min in group LN (p <0.001). The difference was statistically significant. The mean time of onset of sensory block was 6.53 ±1.60 min and 4.00 ±1.69 min (p =0.001); the mean time to achieve a maximum height of the sensory block was 11.53 ±3.72 min and 6.67 ±1.45 min (p <0.001) in groups LC and LN, respectively and were statistically significant. The median maximum block height was comparable in both groups. The maximum motor block achieved and motor block at the time of rescue analgesia were comparable in both groups. Intraoperative and postoperative hemodynamic parameters (heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP)) were comparable among the groups LC and LN, except in DBP at 90 mins, where in group LC the mean was 77.00 ±6.32 min and in group LN it was 81.73 ±6.25 min, which was statistically significant. Sedation scores were comparable in both groups intraoperatively and postoperatively. None of the patients had any sedation in either ofthe groups, and all the patients were easily arousable in group LC and group LN, respectively. No major side effects were observed in either of the groups except one patient (6.7%) in group LC and one patient (6.7%) in group LN developed nausea, and five patients (33.3%) in group LC and three patients (20.0%) in group LN had shivering, which was managed promptly. Conclusion Addition of 15 mcg of clonidine to 3 mL (15 mg) of 0.5% hyperbaric levobupivacaine provides a longer duration of effective analgesia with minimal side effects.

A 35-year-old multiparous woman, at 36 weeks of singleton gestation with a history of poorly controlled hyperthyroidism, presented in obstructed labour and thyroid storm (Burch-Wartofsky score: 50); she was anxious, agitated, pyrexic, tachycardic, hypertensive, with pedal oedema, atrial fibrillation and bearing live foetus. Following intravenous hydrocortisone and oral digoxin, while on Oxygen supplementation, she had an emergency Caesarean section under subarachnoid block, plus titrations of intravenous labetalol and propofol. Intraoperatively, her haemodynamic parameters remained stable and a live foetus was extracted with APGAR scores of 5 and 7 at 1 and 5 minutes of birth, respectively. Postoperatively, she received multidisciplinary management in the intensive care unit (ICU) culminating in her recovery and discharge. This report highlights the anaesthetic challenges and the critical significance of judicious subarachnoid anaesthetic technique, in the management of a patient with the combination of thyroid storm and obstructed labour in poor-resourced setting.

Background: Laparoscopic cholecystectomy (LC) is commonly performed under general anesthesia; however, the use of subarachnoid block (SAB) as a regional anesthetic technique offers potential benefits, including reduced opioid use and faster recovery. Objective: To assess the feasibility and safety of performing laparoscopic cholecystectomy under SAB, focusing on anesthetic outcomes, intraoperative hemodynamics, postoperative pain, recovery time, and complications. Methods: This prospective clinical study was conducted at Barind Medical College, Rajshahi, from June 2023 to June 2024, involving 72 patients undergoing elective laparoscopic cholecystectomy. Patients were randomly assigned to either SAB or general anesthesia. The SAB group received 0.5% bupivacaine heavy at the L3-L4 intervertebral space. Primary outcomes measured were intraoperative hemodynamic stability, postoperative pain scores (using the Visual Analog Scale), recovery time, and complications (hypotension, bradycardia, respiratory depression). Data were analyzed using SPSS, with a significance level set at p &lt; 0.05. Results: In the SAB group, 85.7% of patients experienced stable hemodynamics, with an average systolic blood pressure decrease of 15 mmHg (± 3.2 SD), and a heart rate reduction of 10 bpm (± 4.1 SD). Postoperative pain scores were significantly lower in the SAB group (3.1 ± 1.4) compared to the general anesthesia group (5.7 ± 2.0, p &lt; 0.01). Recovery time was reduced by 30%, with the SAB group having an average recovery time of 4.5 hours (± 1.2 SD). Intraoperative complications, such as hypotension (12%) and bradycardia (9%), were lower compared to the general anesthesia group, where the incidence of hypotension was 25% and bradycardia 18%. Standard deviation for recovery times was 1.2 hours for SAB compared to 2.0 hours for the general anesthesia group. Additionally, the p-value for postoperative opioid consumption was 0.02, indicating a significant reduction in opioid use in the SAB group. A detailed analysis showed a significant reduction in nausea and vomiting episodes (p &lt; 0.05) in the SAB group. Conclusion: Subarachnoid block is a feasible and safe anesthetic alternative for laparoscopic cholecystectomy, offering superior postoperative recovery, reduced opioid requirements, and fewer complications compared to general anesthesia.

Spinal anesthesia is a fundamental and widely adopted technique in modern clinical practice. However, its application in patients with abnormal spinal anatomy remains contentious due to heightened risks of technical failure, neurological injury, and hemodynamic instability. This review synthesizes recent advances in the use of spinal anesthesia in this complex patient population, providing clinical insights and practical recommendations derived from a comprehensive analysis of over 40 studies retrieved from the PubMed and Web of Science databases. Findings suggest that subarachnoid block may offer higher success rates than epidural block in patients with a history of spinal surgery. Among individuals with scoliosis, the failure rate of neuraxial block was markedly higher in those with a Cobb angle greater than 50° (26.9%) compared to those with milder deformities (7.5%). Furthermore, symmetrical bilateral spread of local anesthetics was more frequently observed in patients with left-sided scoliosis (52.9%) than in those with right-sided curvature (28.1%). To optimize puncture success, a needle insertion angle of 4.1±2.45° from the midline is recommended for patients with Cobb angles less than 50°, and 9.14±2.45° for those with Cobb angles exceeding 50°. In cases of ankylosing spondylitis, the paramedian approach, in combination with electromagnetic needle tracking systems such as SonixGPS®, has shown improved procedural efficacy. Despite these promising developments, large-scale, multicenter clinical trials are urgently required to establish standardized protocols, refine anesthetic dosing strategies, and reduce the incidence of neurological complications in patients with altered spinal anatomy.

Ankylosing spondylitis (AS) poses considerable challenges for anesthesiologists due to its effect on spinal anatomy and potential airway difficulties. The characteristic ossification and vertebral fusion - commonly referred to as a "bamboo spine" - leads to rigidity and impaired spinal mobility, often complicating neuraxial anesthetic techniques. This study aimed to assess whether a preprocedural ultrasound-assisted approach improves the success rate of dural puncture with fewer needle attempts compared to the traditional landmark-guided technique in patients with altered spinal anatomy due to AS. Sixty American Society of Anesthesiologists physical status I and II patients aged 18-60 years with AS, scheduled for elective total hip arthroplasty, were enrolled and randomly divided into two equal groups. Group I received ultrasound-assisted subarachnoid blocks, whereas Group II underwent the conventional landmark-based approach. Hemodynamic parameters, total number of needle attempts, and the time required to administer the block were recorded. The primary outcome was the number of attempts for successful dural puncture. Secondary outcomes included time taken and postprocedural complications. Group I (ultrasound-guided) demonstrated a significantly higher first-attempt success rate compared to Group II. Although the ultrasound method showed a slightly increased procedural duration, the difference was not statistically significant, and postprocedural complications were comparable. Ultrasound guidance notably improves first-pass success rates for subarachnoid block in patients with AS, making it a valuable technique for spinal anesthesia in such cases.

Background: Spinal anaesthesia is the standard technique for elective caesarean section due to its simplicity, rapid onset, and maternal safety profile. While combining hyperbaric bupivacaine with intrathecal fentanyl enhances anaesthetic efficacy, the sequential drug administration may influence the spread, block dynamics, and haemodynamic stability.Methods: In this prospective, randomised controlled study, 180 ASA I-II parturients were allocated to either Group M (premixed bupivacaine 9 mg + fentanyl 15 mcg) or Group S (sequential administration of the same drugs). Primary outcomes were time to achieve T5 sensory level, duration of sensory and motor blocks, and incidence of hypotension. Secondary outcomes included vasopressor use, Apgar scores, and umbilical cord blood gas analysis.Results: Group S achieved T5 sensory level significantly faster than Group M (2.88 ± 2.22 vs. 6.04 ± 2.59 min; P = 0.0001). The duration of sensory block was longer in Group S (151.59 ± 22.46 min vs. 123.49 ± 22.64 min; P = 0.0001). Incidence of hypotension was lower in Group S (1.1%) compared to Group M (2.2%) (P = 0.563). Phenylephrine use was also reduced in Group S (P = 0.563). Apgar scores and umbilical cord blood gases were comparable between groups (P > 0.05).Conclusion: Sequential intrathecal administration of hyperbaric bupivacaine and fentanyl provides superior sensory block dynamics and improved haemodynamic stability compared to premixed administration, without compromising neonatal outcomes. This technique is simple, effective, and suitable for routine obstetric anaesthesia.

Objective: To evaluate the effectiveness, onset time, duration, and quality of both sensory and motor block, along with hemodynamic stability and postoperative pain relief, between 0.75% hyperbaric ropivacaine and 0.5% hyperbaric levobupivacaine during subarachnoid block in patients undergoing percutaneous nephrolithotomy (PCNL) procedures. Methods: This prospective, randomized, observer-blinded study compared the efficacy of 0.75% hyperbaric ropivacaine and 0.5% hyperbaric levobupivacaine for subarachnoid block in 150 patients undergoing percutaneous nephrolithotomy (PCNL) surgeries. Patients were randomly allocated into two groups: Group R (n=75) received 4 ml of 0.75% hyperbaric ropivacaine, and Group l (n=75) received 4 ml of 0.5% hyperbaric levobupivacaine intrathecally. The onset and duration of the sensory and motor blockade, analgesia, perioperative hemodynamic variations, side effects, and complications were evaluated. Results: Group l showed significantly earlier onset times for sensory (7.96±1.13 min vs. 9.99±2.57 min; P&lt;0.0001) and motor blocks (2±0.62 min vs. 2.74±0.9 min; P&lt;0.0001) compared to Group R. The duration of sensory block (83.33±10.18 min vs. 59.57±8.15 min), analgesia (145.49±7.93 min vs. 127.8±6.22 min), and motor block (287.25±40.72 min vs. 199±24.38 min) were significantly longer in Group l (P&lt;0.0001). The hemodynamic parameters remained stable in both groups, with no significant differences between the groups. The incidence of side effects was comparable between the groups. Conclusion: In conclusion, 0.5% hyperbaric levobupivacaine provides a faster onset and prolonged duration of sensory and motor blockade, as well as extended analgesia, compared to 0.75% hyperbaric ropivacaine for subarachnoid block in PCNL surgeries, with a similar safety profile.