Dexmedetomidine versus sufentanil as adjuvants to bupivacaine for brachial plexus block during upper extremity surgery: a randomized clinical trial

Abstract Background: Brachial plexus block (BPB) has been accepted as a reliable alternative for general anesthesia in upper limb surgeries. Adding adjuvant drugs like dexmedetomidine and sufentanil has been shown to have clinical and pharmacologic advantages. In this randomized parallel clinical trial, we aim to compare the effects of these two adjuvants for bupivacaine in BPB. Methods: In this double-blinded study, by using computer-assisted block randomization, 40 patients ranged from 20 to 65 years old and scheduled for elective upper limb surgeries were assigned to two equal study groups (n = 20), receiving 1 mL of 5 μg.mL-1 sufentanil (group S) or 1 mL of 100 μg.mL-1 dexmedetomidine (group D) in adjunction to 30 mL of 0.5% bupivacaine for supraclavicular BPB under the guidance of ultrasonography. Characteristics of local anesthesia and postoperative analgesia were evaluated (n = 40). Results: The duration of blocks significantly improved in group S (sensory: estimated median difference (EMD) [95%CI] = 100.0 [70.0~130.0], p < 0.001; motor: EMD [95%CI] = 120.0 [100.0~130.0], p < 0.001). Group S also had significantly longer postoperative analgesia and lower opioid consumption within 24 hours after the surgery (EMD [95%CI] = 4.0 [3.0~7.0], p < 0.001; EMD [95%CI] = -5.0 [-5.0~-5.0], p < 0.001; respectively). None of the patients showed adverse effects concerning vital signs, nausea, or vomiting. Conclusion: Our study showed that during ultrasound-guided supraclavicular BPB, sufentanil is a fairly better choice than dexmedetomidine as an adjuvant for bupivacaine and can provide preferable sensory and motor blocks. No significant side effects were seen in either of the study groups.

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.

Qualitative Histologic Assessment vs. Geomorphometric Analysis of Nerve Fiber Shape after the Intraneural Application of Liposomal Bupivacaine / Evaluación Histológica Cualitativa Versus Análisis Geomorfométrico de la Forma de la Fibra Nerviosa Después de la Aplicación Intraneural de Bupivacaína Liposomal

SUMMARY: The preserved form of all components of the nerve fiber is a prerequisite for the proper conduction of the nerve impulse. various factors can change the shape of nerve fibers. In everyday practice, qualitative histological analysis is the gold standard for detecting changes in shape. Geometric morphometry is an innovative method that objectively enables the assessment of changes in nerve fibers' shape after local anesthetics action. A total of sixty sciatic nerves were used as material, which was intraneural injected with saline solution in the control group (n=30), and a solution of 1.33 % liposomal bupivacaine (n=30) in the test group. After the animals were sacrificed, nerve samples were taken and histological preparations were made. The preparations were first described and examined using a qualitative histological method, after which digital images were made. The images were entered into the MorphoJ program and processed using the method of geometric morphometry. Qualitative histological examination revealed no differences in nerve fibers after intraneurally applied physiological solution and liposomal bupivacaine. Using the method of geometric morphometry, a statistically significant change in the shape of axons was found after intraneurally applied saline solution and liposomal bupivacaine (p=0.0059). No significant differences in histological changes were found after the qualitative histological analysis of nerve fiber cross-section preparations. A statistically significant change in the shape of nerve fiber axons was observed after geometric morphometric analysis of digital images after intraneural application of saline and liposomal bupivacaine.

La forma conservada de todos los componentes de la fibra nerviosa es un requisito previo para la conducción correcta del impulso nervioso. Varios factores pueden cambiar la forma de las fibras nerviosas. En la práctica diaria, el análisis histológico cualitativo es el estándar de oro para detectar cambios de forma. La morfometría geométrica es un método innovador que permite evaluar objetivamente los cambios en la forma de las fibras nerviosas después de la acción de los anestésicos locales. Se utilizó como material un total de sesenta nervios ciáticos, que se inyectaron intraneuralmente con solución salina en el grupo control (n=30), y una solución de bupivacaína liposomal al 1,33 % (n=30) en el grupo de prueba. Después de sacrificados los animales, se tomaron muestras de nervios y se realizaron preparaciones histológicas. Primero se describieron y examinaron las preparaciones utilizando un método histológico cualitativo, después de lo cual se tomaron imágenes digitales. Las imágenes fueron ingresadas al programa MorphoJ y procesadas mediante el método de morfometría geométrica. El examen histológico cualitativo no reveló diferencias en las fibras nerviosas después de la aplicación intraneural de solución fisiológica y bupivacaína liposomal. Usando el método de morfometría geométrica, se encontró un cambio estadísticamente significativo en la forma de los axones después de la aplicación intraneural de solución salina y bupivacaína liposomal (p = 0,0059). No se encontraron diferencias significativas en los cambios histológicos después del análisis histológico cualitativo de las preparaciones de secciones transversales de fibras nerviosas. Se observó un cambio estadísticamente significativo en la forma de los axones de las fibras nerviosas después del análisis de morfometría geométrica de imágenes digitales después de la aplicación intraneural de solución salina y bupivacaína liposomal.

Clinical efficacy of combined spinal and epidural anesthesia with isobaric bupivacaine in older adult patients undergoing artificial femoral head replacement / 中国基层医药

Objective:To investigate the clinical efficacy of combined spinal and epidural anesthesia with isobaric bupivacaine in older adult patients undergoing artificial femoral head replacement.Methods:The clinical data of 50 older adult patients who underwent artificial femoral head replacement in Zhuji Third People's Hospital between January 2016 and January 2020 were retrospectively analyzed. The patients were divided into a control group ( n = 22) and a combined anesthesia group ( n = 28) according to different anesthesia methods. The control group was subjected to epidural anesthesia with bupivacaine. The combined anesthesia group underwent combined spinal and epidural anesthesia with isobaric bupivacaine. The excellent and good rate of anesthesia as well as heart rate and mean arterial pressure measured before and 10 minutes after anesthesia, at 1 hour of surgery and at the end of surgery were compared between the two groups. Time to anesthesia onset and time to block completion were recorded in each group. Results:The excellent and good rate of clinical efficacy in the combined anesthesia group was significantly higher than that in the control group [85.71% (24/28) vs. 59.09% (13/22), χ2 = 4.54, P < 0.05]. There were no significant differences in heart rate and mean arterial pressure between the two groups before and 10 minutes after anesthesia, at 1 hour of surgery and at the end of surgery ( t = 0.83, 0.60, 1.13, 1.21; 0.98, 0.60, 0.85, 0.88, P > 0.05). The time to anesthesia onset and the time to block completion in the combined anesthesia group were shorter than those in the control group ( t = 4.99, 2.29, both P < 0.05). Conclusion:Combined spinal and epidural anesthesia with isobaric bupivacaine can increase the excellent and good rate of anesthesia effects and has no obvious effect on hemodynamics in patients undergoing artificial femoral head replacement. Combined spinal and epidural anesthesia takes a shorter time to anesthesia onset and a shorter time to block completion than spinal or epidural anesthesia.

HEMODYNAMICS EFFECT OF BUPIVACAINE AND LEVOBUPIVACAINE IN PAEDIATRIC ABDOMINAL SURGERIES

Regional analgesia features a prime role within the multimodal analgesia approach for surgical pain management. currently each day it's common apply of using transverses abdominis plane block (TAP Block) with numerous sorts of native anaesthetics and adjuvants, as a multimodal pain relieving remedy used worldwide for intra and postoperative pain management in several surgeries. However, only a few studies are done wherever hemodyanamics effects when bupivacaine versus levobupivacaine have compared. Aim of this study to examine the consequences of bupivacaine vs levobupivacaine in patients undergoing lower abdominal surgeries and their effects on hemodynamics ( the blood pressure, HR, and SpO2). Method: A randomised double-blind management study conducted when approval from IEC Ref. code-92nd IIB Thesis / P4 . The study has fifty patients, with ASA I – II physical status, as well as each sex and 2-10 years cluster age and who set up for abdominal surgery notably lower abdominal . 25 patients set in every group and every which way allotted: cluster Bupiva and Levobupiva . All patients were well well-read regarding the procedure, drugs, and effects of drugs, and untoward complications. well-read written consent was taken from each patient before involving them within the study. primary objective is to examine the impact of those medicine on Blood pressure, HR, and SPO2 & Secondary objective was to check rescue physiological condition reduction within the surgical period. After the comparison between these 2 clusters, The mean SBP of group Bupiva was found below that of group Levobupiva . and located to be important at fifteen min, one hour, a pair of hr, and four hr and insignificant at baseline zero min, thirty min, half dozen hr (p=0.092), twelve hr, eighteen hr, and twenty four h.differences is insignificant in comparison the DBP at any purpose of your time from baseline to 24 hr. On comparing the center rate, variations were found insignificant from baseline (p = 0.897), 0 min (p = 0.651), 30 min (p = 0.096), 1hr (p = 0.192), 2 hr (p=0.390), four hour (p=0.525), half dozen hr (p=0.469), twelve hr (p=0.443), eighteen hr (p=0.288) to twenty four hr (p=0. 390) except at fifteen min (p=0.010) that was the mean pulse rate of cluster Bupiva is over that of group Levobupiva at one,5 min. On comparison the SPO2differences were insignificant at baseline (p = 0.620), 15 min (p = 0.108), thirty min (p=0.353), 1 hr (p = 0.789), 2 hr (p = 0.364), 4 hr (p = 0.292) and 6 hr (p = 0. 198) however important at 0 min (p = 0.002), 12hr (p = 0.012), 18hr (p = 0.002) and24 hr (p = 0.028) wherever the mean SPO2 of cluster Bupiva was abundant below the group Levobupiva. Stable hemodynamics for a extended period were provided by Levobupivacaine as compared to Bupivacaine.

Clinical Comparative Evaluation of Bupivacaine with Fentanyl and Ropivacaine with Fentanyl in Upper Limb Surgery Under Supraclavicular Brachial Plexus Block

Introduction: A lot of surgeries are now performed to reduce a number of physical ailments. Although these surgeries are done to reduce the sufferings these inevitably lead to a lot of pain for the patient. Material and Methods: Our study comprises of 60 patients who had undergone elective upper limb surgery in a tertiary care centre of central India. Patients of both genders, in age group 18-60 years with American Society of Anaesthesiology (ASA) grade I or II were included in our study and divided in two groups of 30 each. Results: Data was entered into MS-Excel sheet and analysed by SPSS version 20. Quantitative data was compared by using student t-test and qualitative data by using chi-square test and Fisher exact test, as applicable. P<0.05 was considered as statistically significant. Both the groups were similar in demographic and surgical characteristics. However, we found that the group given bupivacaine and fentanyl had longer duration of sensory and motor block and post-operative analgesia than ropivacaine and fentanyl group (p<0.001). Conclusion: Combination of bupivacaine with fentanyl provides longer duration of sensory block, motor block and postoperative analgesia without any major side effects than combination of ropivacaine with fentanyl with comparable haemodynamic in both groups.

Anestesia raquídea con bupivacaína isobárica en cesáreas / Spinal anesthesia with isobaric bupivacaine in cesarean sections

En la anestesia para las cesáreas, la anestesia raquídea con bupivacaína hiperbárica constituye la elección habitual en nuestro medio. Existen dos formas de bupivacaína disponibles, la isobárica (BI) y la hiperbárica (BH). La utilización de la BI es poco frecuente por lo que es relevante conocer la experiencia en su utilización para las anestesias de las cirugías obstétricas. El objetivo del estudio fue caracterizar la utilización de BI en las anestesias raquídeas para cesáreas. Se realizó un estudio observacional, descriptivo, de corte transversal en 23 pacientes que recibieron anestesia espinal con BI. La edad promedio fue de 28  5 años, la dosis promedio de BI utilizada de 9,4 mg. La latencia promedio fue 90 segundos y el tiempo para la instauración una anestesia adecuada fue en promedio 4,9 minutos. En el 82,6% el nivel anestésico alcanzó el dermatoma T4. En el 21,7% fue necesario administrar efedrina para aumentar la presión arterial. En el 52,1% se presentaron efectos adversos menores. A las 24 horas, el dolor fue nulo en 56,5% y leve en 43,5% de los casos. En conclusión, se encontró que las pacientes alcanzaron un nivel sensitivo adecuado en poco tiempo, con una dosis promedio de BI de 9 mg. Pocos pacientes requirieron la administración de un vasopresor para aumentar la presión arterial. Los efectos adversos fueron menores en casi la mitad de los pacientes. En el post operatorio la mayoría de las pacientes no presentaron dolor

In anesthesia for caesarean sections, spinal anesthesia with hyperbaric bupivacaine is the usual choice in our setting. There are two forms of bupivacaine available, isobaric (BI) and hyperbaric (BH). The use of BI is infrequent, so it is relevant to know the experience in its use for anesthesia in obstetric surgeries. The objective of the study was to characterize the use of BI in spinal anesthesia for cesarean sections. An observational, descriptive, cross-sectional study was carried out in 23 patients who received spinal anesthesia with BI. The average age was 28  5 years, the average dose of BI used was 9.4 mg. The average latency was 90 seconds and the time for establishment of adequate anesthesia was on average 4.9 minutes. In 82.6% of the cases, the anesthetic level reached dermatome T4. In 21.7% it was necessary to administer ephedrine to increase blood pressure. Minor adverse effects occurred in 52.1%. At 24 hours, the pain was null in 56.5% and mild in 43.5% of cases. In conclusion, it was found that the patients reached an adequate sensory level in a short time, with an average dose of BI of 9 mg. Few patients required administration of a vasopressor to increase blood pressure. Adverse effects were minor in almost half of the patients. In the postoperative period, most of the patients did not present pain

Comparative study to assess the effect of ropivacaine and a mixture of lidocaine and bupivacaine on intraocular pressure after peribulbar anesthesia for cataract surgery

Purpose: To compare the efficacy of ropivacaine with a mixture of lidocaine and bupivacaine in peribulbar anesthesia for cataract surgery, in terms of post?block intraocular pressure (IOP). Methods: A one?year comparative study was done to compare two anesthetic solutions in peribulbar anesthesia for cataract surgery, from January 2020 to December 2020 at a tertiary health care hospital. Two hundred patients (40� 70 years of age) planned for small?incision cataract surgery with posterior chamber intraocular lens (IOL) implantation under peribulbar anesthesia were included in the study. A single?site inferotemporal injection was given till a total eyelid drop was observed. The IOP was measured at four time?points: before block (control), 1?, 5?, and 15?minute post?block with a tonometer. Results: The 1?minute post?block mean IOP in both the groups was higher than the baseline levels. This reflected raised intraorbital pressure secondary to peribulbar injection of local anesthetic. However, the rise in 1?minute post?block IOP was significantly less in the ropivacaine group. The 5? and 15?min post?block mean IOP values in the ropivacaine group were significantly lower than the corresponding values of the lidocaine?bupivacaine group and baseline (control) ropivacaine values. Conclusion: The results of this study support that ropivacaine as a local anesthetic drug for peribulbar block for small?incision cataract surgery can be a suitable alternative to the lidocaine朾upivacaine combination. Studies involving a larger sample size are required to consider ropivacaine as a superior drug to the lidocaine朾upivacaine combination.

Effect of continuous intra-incisional bupivacaine on postoperative pain in non-traumatic spinal fixation surgeries: a randomized controlled trial

Abstract Background Continuous injection of local anesthetics by using surgical wound catheters for postoperative pain relief has gained acceptance in recent years. However, whether this method can be alternatively used instead of systemic opioids in different surgical procedures has not yet been elucidated. Objectives The aim was to investigate the effect of continuous injection of bupivacaine through a catheter inside the surgical wound on reducing the postoperative pain of lumbar spine fusion surgeries. Methods In this clinical trial, 31 patients undergoing non-traumatic lumbar spine stabilization surgery were randomly assigned to receive (n = 15) or do not receive (n = 16) bupivacaine through a catheter inside the surgical wound, postoperatively. Pain intensity (NRS), dose of required morphine, and drug-related complications within 24 hours of intervention were assessed and compared by the Mann-Whitney and independent t-test. Results Mean pain intensity was significantly lower in the case group over the first postoperative hour in the recovery room (p < 0.001), which continued for the first 2 hours after entering the ward. The mean morphine intake was lower in the bupivacaine group during the first postoperative 24 hours (16 ± 0.88 vs. 7.33 ± 0.93 mg, p < 0.001). The two groups were not significantly different regarding drug-related complications. Conclusion Continuous intra-incisional infusion of bupivacaine helped better pain reduction during the early postoperative hours while sparing morphine consumption in the first postoperative day.

Anestesia espinal con bupivacaína más morfina en cirugía de urgencia de fractura intertrocantérica de cadera / Spinal anesthesia with bupivacaine plus morphine in urgent intertrochanteric hip fracture surgery

Introducción: La fractura de cadera en el anciano es una entidad frecuente y tiene gran incidencia en el mundo y en Cuba por el envejecimiento. Objetivo: Evaluar la eficacia de la anestesia espinal con bupivacaína más morfina en la cirugía de fractura intertrocantérica de cadera. Métodos: Se realizó un estudio clínico, experimental, no aleatorizado, prospectivo y de corte longitudinal en el Hospital Universitario Faustino Pérez Hernández de Matanzas de octubre de 2017 a octubre de 2019. El universo estuvo conformado por todos los pacientes quirúrgicos con fractura de cadera del hospital. La muestra se realizó por muestreo intencional, por 120 pacientes elegidos a criterio de los investigadores. Grupo control (B): Anestesia subaracnoidea con bupivacaína 0,5 por ciento 10 mg. Grupo estudio (M): Anestesia subaracnoidea con bupivacaína 0,5 por ciento 7 mg más 0,2 mg de morfina. Cada grupo estuvo integrado por 60 pacientes. Las variables analizadas fueron las siguientes: grupos de edades, género, estado físico, nivel de punción, tiempo de inicio del bloqueo motor, hipotensión arterial, uso de vasopresores y complicaciones secundarias a la técnica anestésica. Resultados: Predominó grupo de 84 y 90 años, género femenino y ASA III. La punción lumbar se realizó entre L3-L4. El tiempo de inicio del bloqueo motor fue 1,3 veces menor en el grupo M. Prevaleció la hipotensión arterial en el grupo B; y uso de vasopresores en ambos grupos. Predominó el prurito, grupo M, y la bradicardia, grupo B como complicaciones. Conclusiones: La asociación bupivacaína/morfina en anestesia espinal en adulto mayor para fractura de cadera proporciona mejores resultados sin complicaciones mayores(AU),

Introduction: Hip fracture in the elderly patient is a frequent entity with a high incidence worldwide and in Cuba due to aging. Objective: To assess the efficacy of spinal anesthesia with bupivacaine plus morphine in intertrochanteric hip fracture surgery. Methods: A clinical, experimental, nonrandomized, prospective, prospective and longitudinal study was carried out in Faustino Pérez Hernández University Hospital of Matanzas, from October 2017 to October 2019. The universe consisted of all surgical patients with hip fracture attended in the hospital. The sample was made by purposive sampling, consisting of 120 patients chosen at the discretion of the researchers. The control group (B) was administered subarachnoid anesthesia with 10 mg of bupivacaine 0.5 percent. The study group (M) was administered subarachnoid anesthesia with 7 mg of bupivacaine 0.5 percent. plus 0.2 mg of morphine. Each group consisted of 60 patients. The following variables were analyzed: age groups, gender, physical condition, puncture level, motor block onset time, arterial hypotension, use of vasopressors, and complications secondary to the anesthetic technique. Results: The predominant age group was 84 and 90 years old, together with female gender and ASA III. Lumbar puncture was performed between L3 and L4. The motor block onset time was 1.3 times shorter in the M group. Arterial hypotension prevailed in the B group; apart from the use of vasopressors in both groups. As complications, there was a predominance of pruritus in the M group and bradycardia in the B group. Conclusions: The association bupivacaine/morphine in spinal anesthesia for hip fracture among elderly adults provides better outcomes without major complications(AU)

Comparative study of epidural fentanyl with bupivacaine and epidural tramadol with bupivacaine for postoperative pain management in orthopedic lower limb surgeries

Introduction: Pain is a complex subjective sensation that is difficult to quantify in a repeatable manner. Surgical pain is observed to be more intense post-surgery and then fades in the next 24 h. Epidural anesthesia/analgesia is the most widely used technique for lower limb surgeries because of its good sensory and motor block property, reduces stress response, and maintains sufficient spontaneous respiration and hemodynamic stability. Materials and Methods: The study looked at 100 individuals between the ages of 20 and 60 who underwent elective lower limb surgery and were classified as ASA I and II. The patients were split into two 50-person groups. The adverse effects of nausea, vomiting, respiratory depression, urine retention, and pruritus, as well as the quality and duration of postoperative analgesia, were investigated. The patient was monitored for 48 h after surgery. Results: A total of 100 patients were included in the study, where the least age of the patient was 19 years and the greatest age was 75 years. In group T, maximum patients belong to the age group of 26–35 years, whereas in group F maximum patients belong to the age group of 36–45years. In group T, 41 (82%) were males and 9 (18%) were females. In group F, 37 (74%) were males and 13 (26%) were females. Conclusion: Our findings show that epidural tramadol and epidural fentanyl are equally effective, except for fentanyl’s shorter duration of action. Fentanyl also has a moderate sedative effect, which is beneficial in the postoperative period.

Comparison Of Magnesium Sulphate With Dexamethasone As Adjuvant To Local Anaesthetics For Supraclavicular Brachial Plexus Block

Background:Background and objectives: Brachial plexus block is routinely performed method of regional nerve block. Different adjuvantshave been used to hasten the onset and prolong the duration of peripheral nerve blocks. In this study we compared dexamethasone and magnesium sulphate as an adjuvant to combination of bupivacaine and lignocaine in supraclavicular brachial plexus block with regards to comparison of time required for onset and duration of sensory and motor block, duration of post-operative analgesia and requirement of rescue analgesics in first 24 hours postoperatively. Material And Methods:This prospective, observational, comparative study was performed on 60 patients of ASA class I, II and III in the age group of 18 to 70 years, weighing 40 to 70 kilogram and undergoing lower arm, elbow, forearm and hand surgeriesdivided in to 2 equal groups D and M. Group D received dexamethasone 8mg and group M received magnesium sulphate 500mg along with bupivacaine(0.5%) and lignocaine(2%).Result:Onest of sensory and motor blockade was significantly faster in group D compared to group M (p-0.001, p<0.001 respectively). Duration of sensory and motor blockade and duration of postoperative analgesia was prolonged in group D compared to group M (p-0.008, p-0.034).Conclusion:Addition of dexamethasone or magnesium sulphate as adjuvant in supraclavicular block prolongs postoperative analgesia. Dexamethasone provided quicker onset and longer duration of analgesia with lesser consumption of rescue analgesic in comparison to magnesium sulphate.

0.25% Bupivacaine with 8 mg Dexamethasone and 50 mcg Clonidine as adjuvant on fascia iliaca compartment block in open reduction and internal fixation surgeries to femoral fractures-a prospective randomized study

Background: Fascia iliaca compartment nerve block (FICB) is commonly preferred pain management technique in femoral fractures. Dexamethasone and clonidine as adjuvants to local anesthetics have good analgesic effect with limited adverse effect. Aim and Objectives: To assess the efficacy of bupivacaine with clonidine, bupivacaine with dexamethasone, and bupivacaine alone in fascia iliaca compartment block in cases with femoral fractures. Materials and Methods: The present prospective randomized study included a total of 120 cases undergoing proximal femoral surgeries under subarachnoid block above 21 years. The study cases were randomly divided into three study groups, i.e. 40 participants in each group. Group 1 received 0.25% bupivacaine with 2 ml normal saline, Group 2 received 0.25% bupivacaine with 50mcg clonidine, and Group 3 received with 0.25% bupivacaine with 8mg dexamethasone. Parameters such as heart rate (HR), mean arterial pressure (MAP), systolic blood pressure (SBP), diastolic blood pressure (DBP), oxygen saturation levels, and visual analog scale (VAS) score was monitored and recorded. Results: The mean difference of HR between the study groups was statistically not significant (P > 0.005). The mean SBP, DBP, and VAS score was comparable between study groups. The mean analgesic duration in Group 1 was 6.01 h, in Group 2 was 13.58 h, and in Group 3 was 14.44 h. The mean difference of rescue analgesia requirement and duration of rescue analgesia was statistically significant. No adverse effects toward drugs were noticed. Conclusion: About 0.25% bupivacaine with 8 mg Dexamethasone had better analgesic duration and require minimal rescue analgesia in the first postoperative day than 0.25% bupivacaine with 50 mcg clonidine in cases undergoing femoral surgeries under FICB.

Comparison Between Dexamethasone and Fentanyl as an Adjuvant to Bupivacaine and Lignocaine in Supraclavicular Brachial Plexus Block for Upper Limb Surgery

Objective: To compare the effects of dexamethasone and fentanyl when added to a mixture of bupivacaine and lignocaine in supraclavicular blocks in patients undergoing forearm surgeries. Methods: Sixty-six patients aged between 20 to 60 years old belonging to ASA one or two were recruited prospectively, double-blinded, and randomized way. Supraclavicular block under sonographic guidance was performed in the three groups by using injection bupivacaine (0.5%) 20 cc + injection lignocaine (2%) 10 cc + injection 0.9% normal saline; 2ml (Group S), injection bupivacaine (0.5%) 20 cc + injection lignocaine (2%) 10 cc + injection dexamethasone 8 mg (Group D), and injection bupivacaine (0.5%) 20 cc + injection lignocaine (2%) 10 cc + injection fentanyl 50 µgm (Group F). The onset time of sensory and motor block, duration of sensory and motor block, and hemodynamic variables were recorded. Results: Group D showed a significantly greater sensory and motor block duration than other groups (P = 0.001). Comparison of hemodynamic variables failed to reveal any statistically significant differences between all the groups. Conclusion: Both dexamethasone and fentanyl are good adjuvants in the supraclavicular block, but dexamethasone is better, given faster onset and duration of analgesia.

Periarticular Infiltration (Bupivacaine, Adrenaline, Magnesium Sulphate And Dexmedetomidine) For Postoperative Analgesia In Total Knee Arthroplasty- A Cases Series Study

Background:Total knee arthroplasty is a major surgery associated with severe pain and delayed rehabilitation. Good quality analgesia with minimum side effects is required for post-operative rehabilitation andinfluences overall outcome of patients.Material And Methods:All patients were given spinal anaesthesia. Intraoperatively, all patients received periarticular infiltration with solution of bupivacaine, adrenaline, dexmedetomidine and magnesium sulphate and normal saline. Post-operatively all patients received intravenous diclofenac sodium 75 mg 12 hourly. Postoperative pain using VAS score, sedation using Ramsay sedation score and hemodynamic parameters were observed.Result:The mean VAS score for pain was <2 during the first 48 hours and provided good analgesia to the patients. During the post-operative period hemodynamic parameters remained comparable to baseline and all patients were co-operative, oriented and tranquil. None of the patient developed any side effects.Conclusion:Local infiltration with bupivacaine, adrenaline, dexmedetomidine and magnesium sulphate can be used along with intravenous diclofenac sodium in patients undergoing total knee arthroplasty and is effective, safe and reliable multimodal pain regimen.

Comparison of Analgesic Effects of Levobupivacaine (0.25%) versus Bupivacaine (0.25%) using Ultrasound Guided Transversus Abdominis Plane Block in Total Abdominal Hysterectomy under General Anesthesia — An Interventional Study

Background : Transversus Abdominis Plane (TAP) block is recently being used for effective pain relief following Total Abdominal Hysterectomy (TAH). Ultrasound guided block helps in correct localization of the plane and proper deposition of drugs. This study was done to compare the efficacy of Levobupivacaine and Bupivacaine in TAP block in TAH. Materials and Method : Seventy patients (ASA 1 and 2) prepared for TAH under General Anesthesia were randomly allocated into two groups. Ultrasound guided TAP block was performed bilaterally with 20ml of Levobupivacaine (0.25%) in Group A (n=35) and Bupivacaine (0.25%) in Group B (n=35) on each side of abdomen after skin closure at the end of operation. Intensity of pain was evaluated by 10cm Visual Analogue Scale (VAS) score at 0, 2, 6, 12,24 hours. If VAS >3, 1gram paracetamol infusion was given as rescue analgesic. Duration of analgesia, total rescue analgesic requirement and hemodynamic changes by measuring MAP and PR were noted. Results : VAS at 12 hours was significantly lower in Group A (mean 3.2±1) than Group B (mean 4.1±0.7, p<0.0001). Time of first rescue analgesic requirement was longer in Group A (mean 12.0±1.1h) compared to Group B (mean 11.2±1.1h, p=0.0059). Total analgesic requirement( paracetamol) in 24 hours was lower in Group A (mean 1.7±0.7g) compared to Group B (mean 2.2±0.7g, p=0.007). Hemodynamic changes were comparable in both groups. Conclusion : Levobupivacaine provided better postoperative analgesia than Bupivacaine with stable hemodynamic condition in TAP block.

Development and characterization of PLGA-Bupivacaine and PLGA-S75: R25 Bupivacaine (Novabupi®) biodegradable implants for postoperative pain

Abstract In the hospital environment, postoperative pain is a common occurrence that impairs patient recovery and rehabilitation and lengthens hospitalization time. Racemic bupivacaine hydrochloride (CBV) and Novabupi® (NBV) (S (-) 75% R (+) 25% bupivacaine hydrochloride) are two examples of local anesthetics used in pain management, the latter being an alternative with less deleterious effects. In the present study, biodegradable implants were developed using Poly(L-lactide-co-glycolide) through a hot molding technique, evaluating their physicochemical properties and their in vitro drug release. Different proportions of drugs and polymer were tested, and the proportion of 25%:75% was the most stable for molding the implants. Thermal and spectrometric analyses were performed, and they revealed no unwanted chemical interactions between drugs and polymer. They also confirmed that heating and freeze-drying used for manufacturing did not interfere with stability. The in vitro release results revealed drugs sustained release, reaching 64% for NBV-PLGA and 52% for CBV-PLGA up to 30 days. The drug release mechanism was confirmed by microscopy, which involved pores formation and polymeric erosion, visualized in the first 72 h of the in vitro release test. These findings suggest that the developed implants are interesting alternatives to control postoperative pain efficiently.

Infiltração de anestésicos locais na ferida cirúrgica: efeito sobre a inflamação e cicatriz fibrosa em ratos / Infiltration of local anesthetics into the surgical wound: effect on inflammation and fibrous scar in rats

■ RESUMO Introdução: O alívio da dor após a cirurgia continua sendo um dos desafios médicos mais significativos, principalmente na cirurgia estética. A infiltração da incisão cirúrgica com anestésicos locais tem sido cada vez mais utilizada para reduzir a dor e o uso de analgésicos. No entanto, pouco se sabe sobre o efeito desta injeção na cicatrização. O objetivo é avaliar a interferência dos anestésicos locais na área de infiltrado inflamatório e cicatriz de fibrose em ratos. Métodos: Duas incisões lineares foram feitas cada uma na região dorsal de 40 ratos Wistar. A incisão esquerda foi infiltrada com doses de 1,8ml de bupivacaína, levobupivacaína, ropivacaína ou solução salina 0,9%. A incisão direita não recebeu infiltração, servindo como grupo controle. Após sete dias, amostras das incisões foram coletadas para avaliação morfométrica histológica. Resultados: Quando comparada com os grupos controle, a área de infiltrado inflamatório encontrada foi maior nos grupos bupivacaína, ropivacaína e levobupivacaína. O grupo bupivacaína apresentou um infiltrado inflamatório maior do que a levobupivacaína e a ropivacaína. A área da cicatriz fibrosa foi maior nos grupos levobupivacaína e ropivacaína. Não houve diferença entre os grupos que receberam anestésico e solução salina. Conclusão: Como não houve diferença entre os grupos de anestésico e soro fisiológico, o volume aplicado ou o trauma podem ter sido a causa das maiores áreas de infiltração e cicatriz associadas à aplicação dos anestésicos locais.

■ ABSTRACT Introduction: Pain relief after surgery remains one of the most significant medical challenges, mainly in aesthetic surgery. The infiltration of the surgical incision with local anesthetics has been increasingly used to reduce pain and other analgesic use. However, little is known about the effect of this injection on healing. The objective is to evaluate the interference of local anesthetics in the area of inflammatory infiltrate and fibrosis scar in rats. Methods: Two linear incisions each were made on the dorsal region of 40 Wistar rats. The left incision was infiltrated with doses of 1.8ml of bupivacaine, levobupivacaine, ropivacaine, or 0,9% saline solution infiltration. The right incision did not receive infiltration, serving as a control group. After seven days, samples of the incisions were collected for histological morphometric evaluation. Results: When compared with the control groups, the area of inflammatory infiltrate was found larger in the bupivacaine, ropivacaine, and levobupivacaine groups. The bupivacaine group presented a larger inflammatory infiltrate than the levobupivacaine and ropivacaine. The fibrous scar area was larger in the levobupivacaine and ropivacaine groups. There was no difference between the groups that received anesthetic and saline solution. Conclusion: As there was no difference between the anesthetics and saline solution groups, the volume applied, or the trauma may have been the cause of the larger areas of infiltrating and scar associated with local anesthetics application.

Analgesia posoperatoria en la videolaparascopía de urgencia mediante irrigación de bupivacaína intraperitoneal / Posoperative analgesia in emergency videolaparoscopy through intraperitoneal bupivacaine irrigation

Introducción: La videolaparascopía es un procedimiento frecuente en los servicios de urgencias de cirugía general. El dolor agudo después de estas intervenciones es de naturaleza compleja y requiere un tratamiento analgésico efectivo. Objetivo: Determinar la utilidad del empleo de bupivacaína intraperitoneal en el alivio del dolor posoperatorio en la videolaparascopía de urgencia. Métodos: Se realizó un estudio longitudinal prospectivo y analítico en 80 pacientes mayores de 18 años, anunciados para videolaparoscopía bajo anestesia general orotraqueal en el servicio de urgencias del HMC: Dr. Luis Díaz Soto, desde septiembre de 2016 hasta septiembre de 2018. Los pacientes fueron divididos aleatoriamente en dos grupos de 40 cada uno. Al grupo 1 se aplicó lidocaína transdérmica preincisional en las incisiones de piel y, al término de la cirugía, se irrigaron ambos hemidiafragmas con bupivacaína al 0,25 por ciento. Al grupo 2 se le administró dosis preincisional de analgésicos endovenosos solamente. Resultados: Predominó significativamente el sexo femenino sin diferencia entre grupos. La analgesia posoperatoria fue mejor en el grupo 1 estadísticamente significativa a las 4, 8 y 12 horas. Los requerimientos de analgesia de rescate fueron menores en el grupo 1 (p=0,0024). No se reportaron efectos adversos. Conclusiones: La administración de lidocaína transdérmica preincisional y la instilación de bupivacaína intraperitoneal al final de la videolaparoscopía de urgencia, reduce significativamente el dolor en las primeras horas de posoperatorio. Su aplicación es sencilla, fácil y segura sin evidencias de efectos adversos(AU)

Introduction: Videolaparoscopy is a frequent general surgery procedure in emergency services. Acute pain after these interventions is complex in nature and requires effective analgesic treatment. Objective: To determine the usefulness of intraperitoneal bupivacaine in the relief of postoperative pain in emergency videolaparoscopy. Methods: A prospective, analytical and longitudinal study was carried out in eighty patients older than eighteen years old, announced for videolaparoscopy under orotracheal general anesthesia in the emergency department of Hospital Militar Central Dr. Luis Díaz Soto, from September 2016 to September 2018. The patients were randomly divided into two groups of forty individuals each. Group 1 was applied pre-incisional transdermal lidocaine on skin incisions and, at the end of surgery, both hemidiaphragms were irrigated with bupivacaine 0.25 percent. Group 2 received pre-incisional doses of intravenous analgesics only. Results: The female sex predominated significantly, without difference between the two groups. Postoperative analgesia was better in group 1, insofar it was statistically significant at four, eight and twelve hours. Rescue analgesia requirements were lower in group 1 (p=0.0024). No adverse effects were reported. Conclusions: The administration of pre-incisional transdermal lidocaine and the instillation of intraperitoneal bupivacaine at the end of emergency videolaparoscopy significantly reduces pain during the first hours after surgery. Its application is simple, easy and safe, without evidence of adverse effects(AU)

Síndrome de cauda equina posterior a la administración por vía subaracnoidea de bupivacaina hiperbárica al 0, 75 % / Cauda equina syndrome following subarachnoid administration of hyperbaric bupivacaine 0. 75 %

El síndrome de cauda equina es una patología poco frecuente en el área de anestesiología. Esta se caracteriza por presentar un conjunto de signos y síntomas que involucran: dolor, disminución o abolición de la fuerza muscular, disfunción de esfínteres e hipoestesia de silla de montar. El objetivo del presente trabajo es presentar y discutir el caso clínico de una paciente con diagnóstico de síndrome de cauda equina posterior a la administración por vía subaracnoidea de bupivacaina al 0,75 % hiperbárica. Se trata de paciente femenina de 42 años a quien se le realizó cesárea segmentaria y salpingectomia bilateral con bloqueo anestésico subaracnoideo; y quien posteriormente a las dieciséis horas del posoperatorio presentó: disminución de la fuerza muscular de miembros inferiores e hipoestesia de región de silla de montar, reflejo rotuliano: 0/4 bilateral y retención urinaria. Se le inicia tratamiento farmacológico y fisiátrico inmediatamente establecido el diagnóstico de síndrome de cauda equina. La paciente fue dada de alta el día diez del posoperatorio, con disminución significativa de la clínica antes descrita, evidenciándose posteriormente retención urinaria por lo que requirió sondaje vesical intermitente. Una vez establecido el diagnostico se instaló inmediatamente tratamiento farmacológico y fisiátrico para dar una oportuna resolución de la patología(AU)

Cauda equina syndrome is a rare pathology in the area of anesthesiology. This is characterized by presenting a set of signs and symptoms that involve: pain, decrease or abolition of muscle strength, sphincter dysfunction and saddle hypoesthesia. The objective of this work is to present and discuss the clinical case of a patient with a diagnosis of cauda equina syndrome after the administration of hyperbaric 0.75% bupivacaine via the subarachnoid route. This is a 42-year-old female patient who underwent segmental cesarean section and bilateral salpingectomy with subarachnoid anesthetic block; and who subsequently at sixteen hours postoperatively presented: decreased muscle strength, lower limbs and hypoesthesia of the saddle region, knee jerk reflex: bilateral 0/4 and urinary retention. Pharmacological and physical treatment was started immediately, the diagnosis of cauda equina syndrome was established. The patient was discharged on postoperative day 10, with a significant decrease in the symptoms described above, later evidence of urinary retention, requiring intermittent bladder catheterization. Once the diagnosis was established, pharmacological and physiatric treatment was immediately installed to give a timely resolution of the pathology(AU)