Anestesia multimodal intratecal en cesáreas, cambios que mejoran su eficacia y seguridad: ensayo clínico / Intrathecal multimodal anesthesia in caesarean sections, changes that improve its efficacy and safety: clinical trial

Resumen: Introducción: la concentración y velocidad en la administración de la anestesia multimodal intratecal con fentanilo en cesáreas mejoran la eficacia anestésica manteniendo buen control hemodinámico. Objetivo: evaluar si algunos cambios en la anestesia multimodal intratecal mejoran su eficacia y seguridad en cesáreas. Material y métodos: ensayo clínico, controlado, aleatorizado, doble ciego en mujeres embarazadas programadas para cesárea, distribuidas en tres grupos: grupo F6B2: fentanilo 65 μg + bupivacaína hiperbárica 2.5 mg + morfina 10 μg + dexmedetomidina 5 μg; grupo F6B3: fentanilo 60 μg + bupivacaína hiperbárica 3 mg+ morfina 100 μg+ dexmedetomidina 5 μg; y grupo F7B2: fentanilo 70 μg + bupivacaína hiperbárica 2 mg + morfina 100 μg + dexmedetomidina 5 μg. Se evaluó la eficacia anestésica previo a la incisión, durante la disección de la pared abdominal, al ingreso a cavidad abdominal, en la revisión de correderas parietocólicas y en el postquirúrgico inmediato, así como los signos vitales. Resultados: los grupos F6B2 y F6B3 resultaron tener mayor eficacia anestésica en la revisión de correderas parietocólicas (p = 0.02) y el grupo F7B2 el de mayor seguridad con mejor control hemodinámico a los minutos 1 y 10 (p = 0.03 y p = 0.03 respectivamente). Conclusiones: los cambios en la administración de la anestesia multimodal intratecal con fentanilo mejoraron la eficacia anestésica, pero disminuyen la seguridad sobre el control hemodinámico.

Abstract: Introduction: the concentration and speed in the administration of intrathecal multimodal anesthesia with fentanyl in cesareans section improve anesthetic efficacy while maintaining good hemodynamic control. Objective: to evaluate if some changes in intrathecal multimodal anesthesia improve its efficacy and safety in cesareans section. Material and methods: clinical trial, controlled, randomized, double blind; in pregnant women scheduled for cesarean section, divided into 3 groups: group F6B2: fentanyl 65 μg + hyperbaric bupivacaine 2.5 mg+ morphine 100 μg+ dexmedetomidine 5 μg; group F6B3: fentanyl 60 μg + hyperbaric bupivacaine 3 mg + morphine 100 μg + dexmedetomidine 5 μg; and group F7B2: fentanyl 70 μg + hyperbaric bupivacaine 2 mg + morphine 100 μg + dexmedetomidine 5 μg. The anesthetic efficacy was evaluated prior to the incision, during the dissection of the abdominal wall, upon the admission to the abdominal cavity, in the review of paracolic slides and in the immediate postoperative period, as well as the vital signs. Results: the F6B2 and F6B3 groups turned out to have greater anesthetic efficacy in the revision of paracolic slides (p = 0.02) and the F7B2 group had the highest safety with better hemodynamic control at 1 and 10 minutes (p = 0.03 and p = 0.03, respectively). Conclusions: changes in the administration of intrathecal multimodal anesthesia with fentanyl improved anesthetic efficacy, but decreased safety over hemodynamyc control.

Comparison of Intrathecal Dexmedetomidine and Nalbuphine as an Adjuvant in Hyperbaric Bupivacaine for Saddle Block and Postoperative Analgesia in Patients Undergoing Perianal Surgeries.

Saddle block is the most commonly used anaesthetic technique for perianal surgeries in adults. Perianal surgeries under saddle block are considered as day care surgeries. Major disadvantage is that the low volume of spinally given drug won’t prolong duration of postoperative analgesia. Inj. Dexmedetomidine (α2-Adrenoceptor agonist) and Inj. Nalbuphine (opioid agonist-antagonist) were studied as an adjuvant as to whether they increase the duration of post-operative analgesia. Secondary objectives of this study were to compare hemodynamic stability and side effects among Inj. Dexmedetomidine and Inj. Nalbuphine. METHODSA total of 60 patients with American Society of Anaesthesiologist physical Status I and II scheduled for elective perianal surgeries were randomly allocated into two equal groups in this randomized prospective comparative study. Group D received 0.5% hyperbaric bupivacaine 0.8 mL + 5 mcg dexmedetomidine and group N received 0.5% hyperbaric bupivacaine 0.8 mL + 0.6 mg nalbuphine. Onset and duration of sensory and motor blockade, and duration of analgesia were recorded. Post-operative analgesic consumption and side effects were studied for 24 hours. Statistical analysis was done by using descriptive and inferential statistics using Chi- square test and Student’s t-test. RESULTSDemographic characteristics, duration of surgery, onset of sensory and motor block were comparable. Duration of analgesia was 320.26 ± 89.52 min for dexmedetomidine (D) whereas it was 222.23 ± 25.43 min for nalbuphine (N) with a P value of <0.05. No side effects were noted. CONCLUSIONA dose of 5 mcg dexmedetomidine as an adjuvant seems to be optimal for providing postoperative analgesia with better hemodynamic stability.

Comparative study of intrathecal fentanyl, tramadol, clonidine mixed with bupivacaine for peri and post operative pain relief in lower limb and lower abdominal surgery

Background: Pain relief is of paramount importance in patients undergoing surgery during perioperative and post-operative period. After effective pain relief a smoother post-operative period and early discharge from the hospital is anticipated. Intrathecal and epidural narcotics have been widely used to relieve pain and provide post-operative analgesia. Here three drugs tramadol, fentanyl, and clonidine used as adjuvant with bupivacaine in intrathecal injection for post-operative pain relief and comparative study had been done.Methods: After the study protocol was approved by the Ethical clearance committee of the DMCH, Laheriasarai, Bihar. Study design was prospective, randomized and double-blind techniques. A group of 80 patients undergoing lower abdominal and lower limb surgery were included in the study. Every patient was fully explained about the anaesthesia and surgical procedure before inclusion in the study. The patients were in the (25-65) years age group and belonged to the American Society of Anaesthesiologist (ASA) physical status class I-II and scheduled for lower abdominal and lower limbs surgery were randomly allocated to four groups with equal number: group B [Bupivacaine (35)% 3 cc + 0.4 cc normal saline], group BT [Bupivacaine (5)% 3 cc + 25 mg tramadol], BC [Bupivacaine (0.5)% 3 c.c + 30 μg clonidine], BF [Bupivacaine (0.5)% 3 c.c + 20 μg fentanyl]. All additive drugs used intrathecally were preservative free. All intrathecal punctures were performed in the lateral (Right or Left) position with a (25G) Quinke needle, using the midline approach at the L3-L4 intervertebral space.Results: The study revealed that administration of additives in group BC and group BF did prolong analgesia. In group B, duration of analgesia and mean duration of rescue analgesic requirement was (3.57±0.45) hrs. For group BC it was (9.47±0.85) hrs, for group BF (7.6±1.14) hrs, for group BT (3.72±0.42) hrs.Conclusions:Addition of adjuvants (Fentanyl, Clonidine) to intrathecal bupivacaine for perioperative pain relief does prolong postoperative analgesia and improves the intraoperative quality of analgesia than bupivacaine alone.Background: Pain relief is of paramount importance in patients undergoing surgery during perioperative and post-operative period. After effective pain relief a smoother post-operative period and early discharge from the hospital is anticipated. Intrathecal and epidural narcotics have been widely used to relieve pain and provide post-operative analgesia. Here three drugs tramadol, fentanyl, and clonidine used as adjuvant with bupivacaine in intrathecal injection for post-operative pain relief and comparative study had been done.Methods: After the study protocol was approved by the Ethical clearance committee of the DMCH, Laheriasarai, Bihar. Study design was prospective, randomized and double-blind techniques. A group of 80 patients undergoing lower abdominal and lower limb surgery were included in the study. Every patient was fully explained about the anaesthesia and surgical procedure before inclusion in the study. The patients were in the (25-65) years age group and belonged to the American Society of Anaesthesiologist (ASA) physical status class I-II and scheduled for lower abdominal and lower limbs surgery were randomly allocated to four groups with equal number: group B [Bupivacaine (35)% 3 cc + 0.4 cc normal saline], group BT [Bupivacaine (5)% 3 cc + 25 mg tramadol], BC [Bupivacaine (0.5)% 3 c.c + 30 μg clonidine], BF [Bupivacaine (0.5)% 3 c.c + 20 μg fentanyl]. All additive drugs used intrathecally were preservative free. All intrathecal punctures were performed in the lateral (Right or Left) position with a (25G) Quinke needle, using the midline approach at the L3-L4 intervertebral space.Results: The study revealed that administration of additives in group BC and group BF did prolong analgesia. In group B, duration of analgesia and mean duration of rescue analgesic requirement was (3.57±0.45) hrs. For group BC it was (9.47±0.85) hrs, for group BF (7.6±1.14) hrs, for group BT (3.72±0.42) hrs.Conclusions: Addition of adjuvants (Fentanyl, Clonidine) to intrathecal bupivacaine for perioperative pain relief does prolong postoperative analgesia and improves the intraoperative quality of analgesia than bupivacaine alone.

Efficacy Of Lower Doses Of Hyperbaric Bupivacaine With Opioid Adjuvant In Elective Cesarean Delivery: An Observational Study

Background and aims:Hemodynamic stability following spinal anaesthesia in caesarean delivery may be achieved with lower dose of the drug at the expense of surgical condition which is not desired. So this study was performed to observe whether good surgical condition would be achieved with lower doses of hyperbaric bupivacaine with fentanyl adjuvant during elective caesarean delivery with minimum complications. Methods: After obtaining institutional ethics committee clearance and written informed consent, this prospective observational study was performed among 110 patients,aged between 18-38 years with singleton term pregnancy scheduled for elective caesarean delivery.The study population was randomly divided into 2 equal groups. Group A and Group B patients received 7.5 mg and 10 mg hyperbaric bupivacaine with fentanyl 25 mcg respectively. The onset and duration of sensory and motor block, the time to reach maximum block height, duration of analgesia, intraoperative average mean arterial pressure, heart rate, Apgar score and complications. Data were analyzed using Microsoft excel 2010 and statistical package of social sciences (SPSS) software version 23.The unpaired Student's t-test was used and p value < 0.05 was considered as statistically signicant. Results: The onset of sensory and motor block, the time to reach peak sensory block, the duration of analgesia and motor block in Group B were statistically signicant than Group A. (p value 0.000).Muscle relaxation was adequate in the both groups. There were signicant fall of average mean arterial blood pressure at 5 and 10 minutes following spinal anaesthesia but subsequent values were comparable. The incidence of complications wasminimum in the both groups. Conclusion: The 7.5 mg hyperbaric bupivacaine with 25 mcg fentanyl provides good surgical condition, hemodynamic stability with minimum complications during elective caesarean delivery.

Effect of addition of intrathecal midazolam to 0.5% hyperbaric bupivacaine to prolong the post-operative analgesia in lower abdominal surgeries

Background: Bupivacaine when used alone produces analgesia for 2.5 to 3 hours, making it unsuitable in cases where the duration of surgery is longer and in cases which require further analgesia during post-operative period. Present study is intended to evaluate the effect of addition of intrathecal midazolam to bupivacaine to prolong the post-operative analgesia.Methods: Present clinical study was conducted in Kamineni Institute of Medical Sciences, Narketpally, Nalgonda District, Andhra Pradesh, India. After obtaining approval from institutional ethical committee, present clinical study was undertaken to evaluate the effects of addition of intrathecal midazolam to bupivacaine 0.5% (heavy). The study was conducted on 60 patients undergoing lower abdominal surgeries.Results: Mean onset of analgesia was 190.5 with SD 21.3 in group-C whereas in group-M, mean onset of analgesia was 185.3 with SD 26.81. Mean difference between the groups not showing statistical significance. In the present study the Maximum height of sensory blockade in control and midazolam group was T7 (T6-T8) compared to T7 (T6-T8) midazolam group. Mean duration of sensory blockade was 130.4 with SD 36.36 in group-C whereas in group-M, mean duration of sensory blockade was 191.9 with SD 36.4. Mean difference between the groups showing statistical significance. Mean duration of motor blockade was 176.3 with SD 23.7 in group-C whereas in group-M, mean duration of motor blockade was 208.1 with SD 18.21. Mean difference between the groups showing statistical significance.Conclusions: Midazolam is a useful adjuvant to bupivacaine in subarachnoid block. Intrathecal midazolam combined with intrathecal bupivacaine produces a longer and more effective anaesthesia and analgesia. It also prolongs post-operative analgesia without increasing adverse effects.

​Comparison of Block Characteristics and Hemodynamic Effects of Low Doses of Clonidine and Dexmedetomidine as an Adjuvant to Hyperbaric Bupivacaine for Spinal Anesthesia in Patients Undergoing Lower-limb Surgeries

Background: Various adjuvants are being used with local anesthetics for prolongation of intraoperative and post-operativeanalgesia. Among them, clonidine and dexmedetomidine are two α2-agonists which can be used as neuraxial adjuvants.Dexmedetomidine, a highly selective α2- adrenergic agonist, is a newer neuraxial adjuvant gaining popularity.Objectives: The objective of the study was to compare sensory and motor block characteristics, hemodynamic effects and sideeffects of low doses of clonidine or dexmedetomidine as an adjuvant to 12.5 mg hyperbaric bupivacaine in spinal anesthesiain lower-limb surgeries.Materials and Methods: A total of 90 patients of American Society of Anesthesiology I and II posted for lower-limbsurgeries were randomly allocated into three groups of 30 each. Group B received plain 12.5 mg of hyperbaric bupivacainediluted to 3 ml with normal saline. Group C received 30 mcg clonidine added to 12.5 mg hyperbaric bupivacaine anddiluted to 3 ml. Group D received 3 mcg dexmedetomidine added to 12.5 mg hyperbaric bupivacaine and diluted to 3 mlwith normal saline.Results: Patients in Group D and Group C had a significantly shorter onset time of sensory and motor block and significantlylonger duration of sensory and motor block compared to bupivacaine group. The mean time for sensory regression to S1 segmentwas 301.90 ± 31.96 min in Group D, 283.23 ± 13.59 min in Group C, and 181.70 ± 18.55 min in Group B (B vs. D and B vs. C,P < 0.001). There was a statistically significant difference in the two segment regression of sensory block in Group D (140.32± 17.6 min) when compared to Group C (124.5 ± 16.10 min) and Group B (92.13 ± 11.45 min). The regression of motor blockto Bromage 0 was 262 ± 24.40 min in Group D, 261 ± 24.19 min in Group C, and 164.40 ± 15.26 min in Group B (B vs. D andB vs. C, P < 0.0001). The onset and regression times were comparable between Groups D and C. Time for the first request ofrescue analgesia was nearly equal in Groups D and C and prolonged compared to Group B. Patients were hemodynamicallystable in all the groups.Conclusion: Dexmedetomidine and clonidine have a similar onset of sensory and motor block, prolonged duration of analgesia.Dexmedetomidine provides better analgesia than clonidine

Efficacy of Intrathecal Fentanyl and Butorphanol for Lower Limb Orthopedic Surgery: A Randomized Comparative Study

Intrathecal opioids when added to local anaesthetics decrease their dosage and provide haemodynamic stability. Subarachnoid block is a common anesthesia procedure for lower abdominal or lower limb surgeries including perineal surgeries. Objectives: To assess the efficacy of anesthesia and analgesia between intrathecal fentanyl and butorphanol with bupivacaine heavy 0.5% for lower limb orthopaedic surgery. Methods: About 120 patients, aged 18-75 years, belonging to American society of anesthesiologists (ASA) physical status 1 or 2 and scheduled for elective, lower limb orthopedic surgeries was randomized into two groups. Group A received 2.5ml of 0.5% hyperbaric bupivacaine with 0.5ml (25μg fentanyl) a total volume of 3ml intrathecally. The Butorphanol was diluted using distilled sterile water to obtain 25μg in 0.5ml. This was then added to 2.5ml of 0.5% hyperbaric bupivacaine to make a total volume of 3ml which was given to group B. Results: The times required for onset of sensory and motor blockade were comparable among the two groups. Significantly slower block regression to S2 level was observed in the group receiving intrathecal butorphanol as compared to intrathecal fentanyl (P<.001). A higher number of patients in group A requested for rescue analgesia during the postoperative period than in group B (11 versus 3; P=0.0326). The average times to first request for rescue analgesia were 254.47±9.31 minutes and 291±8.45 minutes in group A and B, respectively (P<0.001). Conclusion: Both 25μg fentanyl and 25μg butorphanol given intrathecally along with 12.5 mg of hyperbaric bupivacaine provide effective anesthesia for lower limb surgeries. Intrathecal bupivacaine-butorphanol mixture provides longer duration of sensory blockade and superior analgesia than intrathecal fentanyl-bupivacaine mixture.

Sequential intrathecal injection of fentanyl and hyperbaric bupivacaine at different rates: does it make a difference? A randomized controlled trial / 대한마취과학회지

BACKGROUND: Previous studies have shown that sequential intrathecal injection of fentanyl and hyperbaric bupivacaine for cesarean section (CS) anesthesia provides a superior anesthetic effect than use of bupivacaine alone, and prolongs postoperative analgesia. Herein, we investigated whether rapid intrathecal injection of fentanyl followed by slow injection of hyperbaric bupivacaine affects the duration of postoperative analgesia, the effectiveness of anesthesia, and hemodynamic status. METHODS: Fifty-six parturients with American Society of Anesthesiologists physical status I or II, aged 18–40 years, and scheduled to undergo elective CS were randomly assigned to 2 groups of 28 patients each. The normal sequential group received sequential intrathecal injections of fentanyl and hyperbaric bupivacaine at the same rate, each with a 5 ml syringe. The rapid sequential group received a rapid intrathecal injection of fentanyl with an insulin syringe, followed by a slow injection of hyperbaric bupivacaine with a 5 ml syringe. The onset of sensory block, the timing of the first rescue analgesia, the doses of rescue analgesics, the degree of postoperative pain, the onset and duration of motor block, the incidence and duration of hypotension, and spinal anesthesia-related complications were recorded. RESULTS: While both approaches had comparable spinal anesthesia-related complications, incidence and duration of hypotension, and doses of ephedrine, the rapid sequential group exhibited a more rapid onset of sensory block, a higher sensory level, and more prolonged postoperative analgesia. CONCLUSIONS: Rapid sequential injection of fentanyl and hyperbaric bupivacaine produced superior anesthesia and more prolonged postoperative analgesia than sequential injections of both at the same rate.

A comparative study between the efficacy of fentanyl with bupivacaine 05% and buprenorphine with bupivacaine 05% for lower abdominal and lower limb surgeries in a Government Tertiary Care Teaching Hospital

Background: Pain is one of the most common and uncomfortable consequences of surgery, feared by all. Effective and rapid relief from pain is always a challenge but is necessary for alleviating nocioception – induced responses like endocrine-metabolic responses to surgery, autonomic reflexes with adverse effects on organ function, reflexes leading to muscle spasm, and other undesirable results. Aim of the study: This study was done to compare the efficacy of intrathecal fentanyl with bupivacaine and buprenorphine with bupivacaine for all lower abdominal and lower limb surgeries. Materials and methods: Totally 60 ASA I and II patients of both sexes for different lower abdominal and lower limb surgeries were chosen for the study and the patients were divided into two groups of 30 patients in each group. Group F received 3 ml of 0.5% hyperbaric bupivacaine with 25 mcg fentanyl and group B received 3 ml of 0.5% hyperbaric bupivacaine with 75 mcg of buprenorphine. In our study, the time taken to achieve T10 level of the sensory blockade was considered as the time of V. Muruganantham, Nalini, Naheed Azar. A comparative study between the efficacy of fentanyl with bupivacaine 0.5% and buprenorphine with bupivacaine 0.5% for lower abdominal and lower limb surgeries in a Government Tertiary Care Teaching Hospital. IAIM, 2019; 6(5): 80-86. Page 81 onset of sensory block tested with pinprick method, motor block assessed by the onset of Bromage scale 3 and it was found that onset of the sensory block with bupivacaine + Fentanyl was earlier than compared with bupivacaine + Buprenorphine. Results: In the postoperative period VAS scores were significantly low for the buprenorphine group (Group B) when compared with fentanyl group (Group F). Conclusion: To summarize buprenorphine has higher efficacy with intrathecal bupivacaine, prolonged duration of postoperative analgesia and also analgesic-sparing effect in the post-operative period when compared to fentanyl.

Combinación de bupivacaína hiperbárica y fentanil como anestesia espinal en pacientes con fractura de cadera / Combination of hyperbaric bupivacaine and fentanyl as spinal anesthesia in patients with hip fracture

Se realizó un estudio observacional, descriptivo y comparativo de 54 pacientes con fractura de cadera, atendidos en el Servicio de Anestesiología del Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora Torres de Santiago de Cuba, desde enero de 2011 hasta diciembre de 2013, con vistas a evaluar la calidad de la analgesia con las combinaciones de bupivacaína hiperbárica a 0,4 por ciento más fentanil. La muestra fue dividida en 2 grupos: los del A recibieron bupivacaína hiperbárica a 0,4 por ciento más fentanil; los del B, bupivacaína hiperbárica a 0,4 por ciento solamente. Se observó que el tiempo de inicio y duración del bloqueo fue mejor en los integrantes del grupo A; asimismo, las variaciones hemodinámicas y respiratorias, así como los efectos adversos no mostraron diferencias entre los grupos. La analgesia posoperatoria fue superior en el primer grupo, de manera que esta técnica resultó efectiva

An observational, descriptive and comparative study of 54 patients with hip fracture, assisted in the Anesthesiology service of Saturnino Lora Torres Teaching Clinical Surgical Provincial Hospital in Santiago de Cuba, was carried out from January, 2011 to December, 2013, aimed at evaluating the quality of the analgesia with the combinations of hyperbaric bupivacaine at 0.4 percent plus fentanyl. The sample was divided into 2 groups: those of the group A received hyperbaric bupivacaine at 0,4 percent plus fentanil; those of the group B, just received hyperbaric bupivacaine at 0,4 percent. It was observed that the beginning and duration time of the blockade was better in the members of group A; also, hemodynamic and respiratory variations, as well as the adverse effects showed no differences between the groups. The postoperative analgesia was higher in the first group, so this technique was effective

A comparative study of hyperbaric bupivacaine versus hyperbaric bupivacaine and fentanyl (12.5 mcg) in subarachnoid anesthesia for lower abdominal and lower extremity surgeries.

Background: This study evaluated the effects of adding Fentanyl 12.5 mcg to hyperbaric Bupivacaine 0.5% for spinal anesthesia with regards to the onset of sensory block, maximum sensory level reached and the time to achieve it, time to two dermatome segment regression, onset of motor block, time for maximum motor blockade, duration of motor block, hemodynamic parameters and incidence of side effects. Methods: Sixty patients, male and female, ASA I or ASA II, aged 18 to 65 years scheduled for elective lower abdominal and lower extremity surgeries were randomized into two groups. Group C (Control group) received 0.5% hyperbaric bupivacaine 13 mg (2.6 ml) and Group S (Study group) received 0.5% hyperbaric bupivacaine 13 mg (2.6 ml) and 12.5 mcg of fentanyl (0.25 ml). Intraoperatively, sensory parameters were assessed by pin-prick method and motor parameters were assessed by modified Bromage scale at different time intervals. Haemodynamic parameters were monitored and side effects were also observed. Results: Both groups were comparable with respect to age, height, weight and duration of surgery. There was statistically significant difference with regard to the onset of sensory block, maximum dermatome level, time to achieve it and time to two segment regression between the two groups. Motor parameters did not differ. Conclusions: It was concluded that the addition of 12.5 mcg Fentanyl to 13 mg of hyperbaric Bupivacaine 0.5% for spinal anesthesia significantly decreases the onset of sensory block, enhances the maximum dermatome level and also prolongs the time to segment regression with better hemodynamic stability.

Comparison of the Level and Side Effects of Spinal Anesthesia with Hyperbaric Bupivacaine in the Supine, Lateral, and Prone Positions

PURPOSE: This study attempted to test whether there are differences in the level and hemodynamic side effects (blood pressure, heart rate, O2 saturation), and nausea & vomiting of spinal anesthesia using hyperbaric bupivacaine according to position (supine, lateral, and prone positions) in orthopedic surgery patients who received podiatric surgery under spinal anesthesia. METHODS: This study was conducted with 53 patients who had received orthopedic surgery under spinal anesthesia at I General Hospital. Data were analyzed using SPSS 20.0 through repeated-measures ANOVA, post-hoc test, Chi-test, and Fisher's exact test. RESULTS: The change of position after spinal anesthesia with hyperbaric bupivacaine caused a change in the level of spinal anesthesia (F=12.768, p<.001). However, no difference of blood pressure, heart rate, O2 saturation and nausea and vomiting caused by the change in anesthesia level was observed, and in prone position, drug was administered for the correction of side effects. CONCLUSION: As expected, recognizing that there can be a change in the level of spinal anesthesia after the change of position in surgical patients, nurse anesthetists should monitor their conditions carefully and continuously.

The Effects of Intrathecal Midazolam Added to Bupivacaine Spinal Anesthesia / 대한마취과학회지

BACKGROUND: Intrathecal additives are often used to enhance spinal anesthesia. Midazolam has been reported to have a spinally mediated antinociceptive effect. The aim of this study was to evaluate the effect of midazolam in addition to hyperbaric bupivacaine in spinal anesthesia. METHODS: Sixty ASA 1 or 2 adult patients scheduled for lower extremity surgery under spinal anesthesia were studied. Patients were allocated randomly to one of four groups to receive 2.8 ml of one of either of the following intrathecal solutions: hyperbaric bupivacaine 12 mg and normal saline 0.4 ml (group 1; n = 15), hyperbaric bupivacaine 12 mg, midazolam 0.5 mg and normal saline 0.3 ml (group 2; n = 15), hyperbaric bupivacaine 12 mg, midazolam 1 mg, and normal saline 0.2 ml (group 3; n = 15), or hyperbaric bupivacaine 12 mg and midazolam 2 mg (group 4; n = 15). The level, onset, and duration of spinal anesthesia as well as hemodynamic changes and side effects were assessed. RESULTS: The duration of spinal anesthesia was increased in the midazolam addition groups. The duration of anesthesia was significantly increased in group 4 compared to the other 3 groups (P<0.05). The onset, blood pressure, heart rate, and levels of sedation were no different between the 4 groups. No neurological deficit or other significant adverse effects were recorded. CONCLUSIONS: The addition of intrathecal midazolam to hyperbaric bupivacaine significantly improve the duration of spinal anesthesia without significant adverse effects. Therefore, the use of intrathecal midazolam in a dose not exceeding 2 mg can be used as an effective additive for spinal anesthesia.

The Characteristics of Clinical Anesthesia Based on the Duration of Lateral Decubitus in Low Dose Hyperbaric Bupivacaine Induced Unilateral Spinal Block / 대한마취과학회지

BACKGROUND: When attempting a unilateral spinal anesthesia, many factors must be considered including patient's position, density and amount of the local anesthetics, needle design, injection speed. We evaluated a duration of lateral decubitus with low dose hyperbaric bupivacaine for maximizing the benefit. METHODS: Hyperbaric 0.5% bupivacaine 6 mg was administered slowly through a 25-gauge Whitacre needle to 60 ASA 1-2 patients undergoing unilateral lower extremity surgery. The patients were randomly allocated to four groups based on the duration of lateral decubitus after spinal anesthesia: 5 minutes in Group I; 10 minutes in Group II; 15 minutes in Group III; 20 minutes in Group IV. Circulatory variables, sensory and motor block level were recorded. RESULTS: The circulatory variables were stable in all patients. In the Group I, the success rate of unilateral motor block was significantly lower than other groups. In the Group IV, the success rate of unilateral sensory block was significantly higher than group I. In the Group II, III, IV, the patient's satisfaction scores were significantly higher than Group I. CONCLUSIONS: When unilateral spinal anesthesia was attempted with 0.5% hyperbaric bupivacaine 6 mg, cardiovascular stability was achieved in the groups that patients are kept in a lateral decubitus for more than 5 minutes after spinal injection, and patient's higher satisfaction scores were achieved in the unilateral motor block and in the groups that patients are kept in a lateral decubitus for more than 15 minutes after spinal injection.

Effect of Hyperbaric Bupivacaine Spinal Anesthesia with Epinephrine / 대한마취과학회지

The effect of spinal anesthesia with hyperbaric bupivacaine with and without 1: 1000 epinephrine were studied in 35 patients. Patients in group A received 0.4% hyperbaric bypivacaine 20 mg and patients in group B received the same anesthetic, only 0.2 mg of epinephrine was mixed to it. The following results were obtained. 1) The highest level of sensory loss was similar in both groups. 2) The duration of sensory loss was significantly longer in group B(391+/-12.9 vs 289+/-18.8min, p<0.05) The duration of motor block was also significantly longer in group B than group A(254 +/-13.7 vs 17l+/-4.4 min). 3) The systolic blood pressure significantly decreased at 20-40 minutes after spinal anesthesia in both groups. 4) The pulse rate in group A significantly increased at 2-10 minutes after spinal anesthesia and in group B, it decreased significantly at 45-50 minutes after spinal anesthesia.