Comparison of efficacy of Interathecal 0.5% Isobaric Levobupivacaine With Fentanyl Versus 0.5% Isobaric Bupivacaine with Fentanyl for Inguinal Hernia Repair

Introduction: As practice of medicine focuses increasinglyon outpatient care, spinal anaesthetics should provide shortacting and adequate anaesthesia without compromising earlyambulation and discharge from day care surgery unit. Bothclinical and preclinical trials have demonstrated a bettersafety profile for Levobupivacaine than for Bupivacaine. Inthis study we proposed to compare a combination of low doseLevobupivacaine with Fentanyl to low dose isobaric racemicBupivacaine with Fentanyl for the characteristics of spinalblockade with respect to onset and duration.Material and Methods: The present study was conductedamong 70 patients who were classified as American Society ofAnaesthesiologists (ASA) physical status I or II, undergoingelective inguinal hernia repair surgeries under spinalanaesthesia divided into two groups of 35 each. Patients inGroup LB were given Levobupivacaine 0.5% isobaric 5 mg(1ml) + Inj. Fentanyl 25 µg (0.5ml) and Group B were givenBupivacaine 0.5% isobaric 5 mg (1ml) + Inj. Fentanyl 25 µg(0.5ml). The onset of motor blockade (Time taken for motorblockade to reach Modified Bromage Scale 1) and duration ofmotor blockade (Regression of motor blockade to ModifiedBromage scale 0) were noted. Sensory and motor blocks wereassessed at the start of surgery and at the end of surgery forcomparison between groups.Results: Intrathecal 0.5% isobaric Levobupivacaine withFentanyl combination has slower onset of sensory blockadeand motor blockade, slower time for achieving peak sensorylevels when compared to 0.5% isobaric bupivacaine withFentanyl combination. But, intrathecal 0.5% isobaricLevobupivacaine has a faster onset of two segment regression,faster S2 regression and faster regression of motor blockwhen compared to 0.5% isobaric bupivacaine with Fentanylcombination. Similarly, the time to ambulation and timeto urination are also early with intrathecal 0.5% isobaricLevobupivacaine.Conclusion: Intrathecal 0.5% isobaric Levobupivacaineoffers an advantage for the patient for faster discharge hencecan be suitable for day care surgeries.

Bupivacaine 0.5% vs. levobupivacaine 0.5% for epidural anaesthesia for caesarean section: a comparative study

Background: Levobupivacaine has been purported to be as efficacious as Bupivacaine for epidural anaesthesia in recent literature.Methods: With the intent to study the same in caesarean section cases in our set up, we observed various intra- and post-operative variables in two groups (Levobupivacaine and Bupivacaine) of 60 healthy parturients. Sixty parturients for elective caesarean section were allocated randomly to receive epidural block with 10-20 ml of either 0.5% Levobupivacaine with Fentanyl 25µg or 0.5% Bupivacaine with Fentanyl 25µg to reach T6 level.Results: Mean total volume in Bupivacaine group was 15.23ml and in Levobupivacaine group was 12.76 ml. The difference was statistically significant. There was significant difference between the groups in the sensory block. The onset of analgesia was earlier in Levobupivacaine group. Mean time was 6.20 minutes in Bupivacaine group and 4.36 minutes in Levobupivacaine group. The duration of motor block was significantly short in Levobupivacaine group. Mean Time for recovery from motor block in Bupivacaine group was 2.5 hours and in Levobupivacaine group 1.5 hours. Mean time to achieve T6 height was earlier in Levobupivacaine group i.e. 16.46 minutes in Bupivacaine group and 13.26 minutes in Levobupivacaine group. Duration of postoperative analgesia was similar. There was no significant difference in neonatal outcome.Conclusions: Levobupivacaine was found to fare better than Bupivacaine in the studied intra and post-operative parameters and is hence recommended over racemic Bupivacaine for epidural block in patients undergoing elective cesarean section.

Gasping infant for emergency neck exploration, anaesthesiologist’s nightmare.

Children are not small adults. They have certain anatomical & physiological differences as compared to adults. Paediatric patients have limited body reserve and so they deteriorate very fast. Anaesthetising paediatric patient requires good clinical judgment and thorough knowledge of paediatric anatomy and physiology. Anaesthetising an infant who has respiratory distress preoperatively increases risk several folds. Also the cause of respiratory distress is vital and that can have an important anaesthetic implications. Here we report a case of a gasping infant operated for emergency neck exploration under anaesthesia, where the cause of respiratory distress was unknown, making the case further interesting and challenging.

Comparative study of intrathecal hyperbaric Bupivacaine with Clonidine, Fentanyl and Midazolam for quality of anaesthesia and duration of post operative pain relief in patients undergoing elective caesarean section.

Pain free postoperative period and early ambulation are the need of the day for mothers caring for their neonates.The use of adjuvants in spinal analgesia has gained popularity in recent times. This prospective randomized study was carried out among 120 patients scheduled for elective caesarian section. They were divided into 4 groups. Group A (Control) received Injection Bupivacaine (Hyperbaric) along with 0.9% Normal saline, Group B, C and D received Clonidine 75 µg, Fentanyl 25 µg and Midazolam 2.5 mg along with injection Bupivacaine (H) respectively. The results of the present study showed that intrathecal Clonidine, Fentanyl and Midazolam can be used safely in parturient, provided strict protocol for preloading is followed by vigilant operative and post-operative monitoring by a trained person. Requirement of postoperative analgesics was found to be significantly reduced in all the study groups when compared with the control group. The highest duration of pain relief was found with Clonidine. Adverse effects were minimal and could be easily managed; no adverse foetal effect was noted with the use of any drug in this study.