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Bupivacaine as local anaesthetic has cardiovascular and neurological toxic effects; ropivacaine on the other hand is known to have fewer side effects. Its safety and some its ability to reduce intra ocular pressure has led to its widespread usage. The aim of our study was to compare the efficacy of inj. Ropivacaine 0.75 % + hyaluronidase 50 IU / mL with inj. bupivacaine 0.5 % + hyaluronidase 50 IU / mL in cataract surgeries under regional anaesthesia. MethodsWe evaluated 60 patients who were posted for small incision cataract surgeries. They were randomly divided by drawing chits in to 2 groups according to the anaesthetics used (ropivacaine / bupivacaine). Evaluation of these patients was done on the basis of sensory onset, motor onset using akinesia score, requirement of rescue analgesic, and time of motor and sensory offset of the local anaesthetic. ResultsInj. ropivacaine 0.75 % showed greater reduction in IOP (p < 0.05). Other parameters such as motor block, sensory block, akinesia score, and requirement of rescue analgesia were comparable between the two groups (p > 0.05). ConclusionsIn patients posted for intra ocular / cataract surgeries, ropivacaine 0.75 % and bupivacaine 0.5 % are comparable, with ropivacaine having better haemodynamic profile and also reduces intra ocular pressure.
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Introduction: Pain was defined by Mountcastle in the year1968 as “that sensory experience evoked by stimuli thatinjures”. It is a subjective feeling and failure to relieve pain inany procedure cannot be accepted, both ethically and morally,and adequate pain relief must be treated as basic human right.Pain relief both in peri-operative and post-operative period isthe crux of anaesthesia. The aim of the study was to evaluatethe efficacy of epidural Dexmedetomidine and Clonidine as anadjuvant to Bupivacaine in patients undergoing infraumbilicalsurgeries.Material and Methods: Seventy (70) patients aged 20-60years (ASA I-II) undergoing infraumbilical surgery wererandomly allocated to two groups- Group BD receivingepidurally 15ml Bupivacaine (0.5%) + Dexmedetomidine(1mg/kg) and Group BC receiving 15ml Bupivacaine (0.5%)+ Clonidine (1mg/kg). After securing I/V line, infusionstarted with R/L and under strict aseptic condition, patientswere administered epidural block via 18G Tuohy needlein the sitting or lateral position at L3-L4 intervertebralspace.Results: We observed that the time taken for the onset ofsensory block at T10 level, time for sensory block upto T6 andthe time taken for maximum motor block is less in Group BDcompared to Group BC. Regarding the post-operative block,the time to sensory two segment regression, time to sensoryregression to S1, time for recovery of motor block and timeto first rescue analgesia were more in Group BD compared toGroup BC. And the difference between the two groups weresignificant (p<0.001).Conclusion: On the basis of the findings of our present clinicalstudy, we can come to conclusion that Dexmedetomidine ismore effective epidural adjuvant compared to Clonidine inpatients undergoing infraumbilical surgery.
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Background: Bupivacaine and Ropivacaine have been extensively studied &their properties with respect to onset, duration and quality of block. This study aims to detect whether addition of clonidine to both of them changes their properties. This study also aims to use lower than usual dosages for both the local anesthetics to prevent adverse effects of local anesthetics.Methods: After obtaining ethical approval, the study was carried out on patients undergoing elective upper limb surgeries. They were randomly divided into two Groups: Group B and Group R. The onset and duration of sensory and motor blockade and other parameters were assessed.Results: The onset of blockade, both sensory & motor was earlier in Ropivacaine as compared to Bupivacaine group. Mean duration of blockade, both sensory & motor, was more in the Bupivacaine group. Conclusions: Addition of Clonidine enabled the use of low concentrations (0.25%) of both the anesthetics. Also, Ropivacaine (0.25%) has faster onset of sensory and motor blockade, shorter duration of action and less motor blockade compared to Bupivacaine.
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Context: Block augmentation by epidural volume extension has been adequately documented but therehave been not enough studies comparing different volumes of normal saline used in this technique toaugment the level of block achieved. The study compares different volumes of normal saline(5,10 and 20ml) for epidural volume extension in combined spinal epidural anaesthesia for lower abdominal surgeries.120 women, aged between 20-60 years belonging to ASA grade I-II undergoing elective lower abdominalsurgeries were included in this study. The patients were randomly allocated into 3 groups and each groupcomprised of 40 patients. GROUP 1(EVE 5) received 10 mg 0.5% bupivacaine heavy (H) intrathecallywith 5 ml normal saline through the epidural catheter as a part of Epidural volume extension. GROUP 2(EVE10) and GROUP 3 (EVE20) received 10 ml and 20 ml of normal saline as a part of Epidural volumeextension respectively in addition to the intrathecal drug. The patients were assessed for sensory blocklevel to loss of pain from pin prick and for motor block using Bromage scale. Peak sensory block height,highest Bromage score, time taken to achieve maximum sensory and motor block and the time to theirrecovery were recorded.Statstical Analysis. was done using statistical software SSPS version 16.0 andEpi- info version 6.0 .Outcome measures were presented as % for qualitative variables and mean±SD forquantitative variables.Demographic data and duration of surgery were similar in all the groups.Sensoryblock augmentation was found to be significantly higher in the EVE10 and EVE 20 groups. There was nodifference in the peak motor block score between the groups during the study. Time to achieve the blockswere significantly shorter for the 20 ml group than the 10 and 5 ml groups; the latter two being comparable.This was associated with a significantly faster motor recovery to Bromage 0 in groups EVE10 and EVE20.
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Introduction: Pain in the postoperative period is the distressing period after any surgeries particularly in the first 24 hours. Postoperative pain is associated with an increase in sympathetic activity leading to increases in heart rate, blood pressure, respiratory rate and even delirium and myocardial insults. Opioids and NSAIDS are very commonly used in the postoperative period in spite of their known adverse effects. So there is a need for a study to find a drug which prolongs the duration of analgesia in the postoperative period without many side effects so that usage of opioids and NSAIDS drugs in the first 24 hours can be decreased. The aim of the study: To compare during supraclavicular brachial plexus block, the single perioperative dose of intravenous Dexamethasone and perineural Dexamethasone effects on onset and duration of sensory and motor blockade ; quality of analgesia and reduction in the dose of opioids in first 24 hour. Materials and methods: A Randomized, Triple-Arm, Double-Blind, Placebo-Controlled Trial. Totally 90 patients were recruited in the study patients undergoing upper limb surgeries under supraclavicular block at govt. Kilpauk medical college hospital and govt. Royapettah Hospital from Sathyan Natarajan, Karthikeyan G, Murugan T. Comparison of analgesic properties of perineural and systemic dexamethasone in patients undergoing upper limb surgeries under supraclavicular block. IAIM, 2017; 4(11): 220-228. Page 221 December 2015 to May 2016 were included in the study. After obtaining written informed consent patients were divided into three groups of 30 in each group. Group A local anesthetics and perineural dexamethasone Group B local anesthetics & intravenous dexamethasone, Group C local anesthetics only. Results: The Sensory and Motor block onset time between the intervention groups group A VS group B and group A VS group C were found to be statistically significant (p < 0.05) and the association between group B VS group c was found to be not statistically significant (p>0.05) as per unpaired t-test. The sensory & motor block duration time showed statistical significance in group A VS group C, group B VS group C (p < 0.05) but group A VS group B had no statistical significance( p > 0.05) as per unpaired t-test. The association of Visual Analog Scale between the intervention groups (group A Vs group C and group B VS group C) and VAS scores at 6, 12 and 24 hours postoperatively were found to be statistically significant since p < 0.05 as per unpaired t-test. The number of doses of opioid required in 24 hours was considered to be statistically significant since p < 0.05 as per unpaired t-test between the intervention groups (group A VS group C and group B VS group C). Conclusion: Systemic Dexamethasone is equally effective as perineural Dexamethasone in providing the significant duration of sensory, motor blockade and quality of analgesia. We come to a conclusion that Dexamethasone consistently decreases the postoperative pain scores and decrease the early & number of doses of opioid consumption (48 hours).
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BACKGROUND: The interscalene brachial plexus block is widely used for pain control and anesthetic purposes during shoulder arthroscopic surgeries and surgeries of the upper extremities. However, it is known that interscalene brachial plexus block is not appropriate for upper limb surgeries because it does not affect the lower trunk (C8-T1, ulnar nerve) of the brachial plexus. METHODS: A low approach, ultrasound-guided interscalene brachial plexus block (LISB) was performed on twenty-eight patients undergoing surgery of the upper extremities. The patients were assessed five minutes and fifteen minutes after the block for the degree of block in each nerve and muscle as well as for any complications. RESULTS: At five minutes and fifteen minutes after the performance of the block, the degree of the block in the ulnar nerve was found to be 2.8 +/- 2.6 and 1.1 +/- 1.8, respectively, based on a ten-point scale. Motor block occurred in the median nerve after fifteen minutes in 26 of the 28 patients (92.8%), and in all of the other three nerves in all 28 patients. None of the patients received additional analgesics, and none experienced complications. CONCLUSIONS: The present study confirmed the achievement of an appropriate sensory and motor block in the upper extremities, including the ulnar nerve, fifteen minutes after LISB, with no complications.
Subject(s)
Humans , Analgesics , Arthroscopy , Brachial Plexus , Median Nerve , Shoulder , Ulnar Nerve , Ultrasonography , Upper ExtremityABSTRACT
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.
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Background: For spinal anesthesia there are drugs which can increase the level and quality of analgesia. Any drug which decreases sensory block level in spinal anesthesia is of great concern as it may need analgesic, sedative, supplement or even conversion to general anesthesia. Ondansetron is one such drug which has been reported to decrease the height of sensory block achieved after subarachnoid administration of bupivacaine. In this prospective observational study, we studied the effect of administration of ondansetron on the level of the sensory block achieved after subarachnoid blockade. Methods: In Group II, 4 mg ondansetron was given and 15 mins before giving spinal anesthesia Group II against control group receiving 2 ml saline intravenous (Group I). 15 mins before giving spinal anesthesia. Both groups received 3.5 ml of bupivacaine heavy was given intrathecally. Sensory and motor block was assessed 5, 15, and 30 mins. We analyzed both highest spinal block level achieved and time to regress to L1 level. Results: We found that in Group II both highest level of sensory block (T6 by median method) duration to regress to L1 level (1.43±0.22 hrs) was lesser as compared to group I and Group III T4 by median method and time to regress from T6 to L1 Group I 2.03±0.06 hrs Group III 1.84±0.27 hrs. Motor block did not differ between groups. Conclusions: We concluded that probably ondansetron was responsible for lower spinal block level and early recovery from spinal anesthesia after intrathecal bupivacaine and should not be given empirically for nausea and vomiting.
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BACKGROUND: The purpose of this study is to compare the anesthetic characteristics in elderly patients who remain in sitting position for 2 min compared with patients that are placed in supine position after induction of spinal anesthesia. METHODS: Fifty-seven patients scheduled for transurethral surgery were randomized to assume supine position immediately after 6.5 mg hyperbaric bupivacaine were injected (L group) or to remain in the sitting position for 2 minutes before they also assumed the supine position (S group). Analgesic levels were assessed bilaterally, using pin-prick. Motor block was scored using a 12-point scale. The mean arterial pressure and heart rate were also recorded. RESULTS: Sensory block levels were significantly lower at all time points for the L group. However, there were no significant differences in the degree of the motor block and hemodynamic changes between the two groups. However, in the L group, ephedrine or atropine were administered to three patients. CONCLUSIONS: We concluded that performing a spinal anesthesia in sitting position was technically easier and induced less hypotension.
Subject(s)
Aged , Humans , Anesthesia, Spinal , Arterial Pressure , Atropine , Bupivacaine , Ephedrine , Heart Rate , Hemodynamics , Hypotension , Supine PositionABSTRACT
BACKGROUND: Spinal anesthesia causes hypotension and bradycardia due to sympathetic nerve block and it is difficult to predict the level of sensory block and the duration of blockade. Recent studies have reported that intravenous phenylephrine can reduce the rostral spread of spinal anesthesia in pregnant women. We think a phenylephrine infusion will be useful for maintaining the baseline blood pressure by reducing the rostral spread of spinal anesthesia during the elective surgery of non-obstetric patients. METHODS: Sixty patients who were undergoing urologic surgery were randomized into two groups: Group C (the control group without phenylephrine) and Group P (with the addition of phenylephrine). After a bolus infusion of 50 microg phenylephrine following the spinal injection, phenylephrine was continuously infused at the rate of 200 microg/hr. We compared the dermatomal spreads of spinal anesthesia, the hemodynamic parameters (blood pressure, heart rate) and the incidences of hypotension between the two groups. RESULTS: At 20 minutes, the level of the upper dermatome blocked against cold sensation was a median of T8 (interquartile range: T8-T10) for the phenylephrine group, as compared with T4 (interquartile range: T4-T6) for the control group (P < 0.001). CONCLUSIONS: Intravenous phenylephrine can decrease the rostral spread of spinal anesthesia during urologic surgery.
Subject(s)
Female , Humans , Anesthesia, Spinal , Autonomic Nerve Block , Blood Pressure , Bradycardia , Cold Temperature , Heart , Hemodynamics , Hypotension , Incidence , Injections, Spinal , Phenylephrine , Pregnant Women , SensationABSTRACT
Desde 1980 que la anestesia peridural (AP) se ha propuesto para manejar el dolor postoperatorio, en especial en cirugías abdominales. A pesar de que ésta es percibida por varios autores, como la analgesia ideal para las cirugías abdominales mayores, hay algunos que prefieren la administración de antiinflamatorios no esteroidales o de opiodes por vía periférica, ya sea en bolos, infusión continua o controlados por el paciente (PCA). Si bien esta última provee mejor analgesia y satisfacción que la administración convencional, no ha demostrado mejorar la morbimortalidad quirúrgica, cosa que sí lo ha hecho la AP. Se realiza una revisión de la literatura con el objetivo de analizar los efectos benéficos y adversos de la anestesia peridural en los pacientes sometidos a una cirugía mayor abdominal. Se concluye que el uso de anestesia epidural intraoperatoria y postoperatoria está asociado a una disminución de la incidencia, severidad de las alteraciones fisiológicas perioperatorias y morbilidad postoperatoria.
Subject(s)
Humans , Analgesia, Epidural , Anesthesia, Epidural , Abdomen/surgery , Analgesia, Epidural/adverse effects , Anesthesia, Epidural/adverse effects , Nerve Block/methods , Blood Coagulation , Postoperative Complications/prevention & control , Pain, Postoperative/prevention & control , Stress, Physiological , Cardiovascular System , Respiratory System , Gastrointestinal TractABSTRACT
BACKGROUND: Spinal anesthesia for urologic surgery in elderly patients is preferred. The addition of opioids to local anesthetics reduces the side effects of spinal anesthesia. This study examined the effects of intrathecal fentanyl 10microgram and 20microgram when administered with hyperbaric 0.5% bupivacaine to elderly patients undergoing urologic surgery. METHODS: Forty-five elderly patients undergoing urologic surgery were randomized into the following three groups: group 1, bupivacaine 7.5 mg; group 2, bupivacaine 5 mg + fentanyl 10microgram; and group 3, bupivacanie 5 mg + fentanyl 20microgram. The total volume of intrathecally injected was adjusted to 1.5 ml with sterile normal saline. Spinal anesthesia was administered with a 25 G Quincke needle at the L3-4 or L4-5 interspace in the lateral position. The neural block was assessed using a pinprick test and the Bromage scale. RESULTS: There were no significant differences in the onset time of the T10 sensory block, peak level of the sensory block, and onset time of the peak level. The duration of the sensory block was significantly shorter in group 2 than in group 1 (P = 0.017). The duration of the motor block was longer in group 1 than in groups 2 and 3 (P = 0.016, P = 0.04). Pruritus was observed more often in group 3 (37.5%) and shivering was more common in group 1 (P = 0.005). CONCLUSIONS: The addition of fentanyl 10microgram and 20microgram to bupivacaine 5 mg provides adequate anesthesia for elderly patients undergoing urologic surgery with fewer side effects, and fentanyl 10microgram is recommended as outpatient anesthesia.
Subject(s)
Aged , Humans , Analgesics, Opioid , Anesthesia , Anesthesia, Spinal , Anesthetics, Local , Bupivacaine , Fentanyl , Needles , Outpatients , Pruritus , ShiveringABSTRACT
BACKGROUND: Spinal anesthesia for urologic surgery in elderly patients is preferred. The addition of opioids to local anesthetics reduces the side effects of spinal anesthesia. This study examined the effects of intrathecal fentanyl 10microgram and 20microgram when administered with hyperbaric 0.5% bupivacaine to elderly patients undergoing urologic surgery. METHODS: Forty-five elderly patients undergoing urologic surgery were randomized into the following three groups: group 1, bupivacaine 7.5 mg; group 2, bupivacaine 5 mg + fentanyl 10microgram; and group 3, bupivacanie 5 mg + fentanyl 20microgram. The total volume of intrathecally injected was adjusted to 1.5 ml with sterile normal saline. Spinal anesthesia was administered with a 25 G Quincke needle at the L3-4 or L4-5 interspace in the lateral position. The neural block was assessed using a pinprick test and the Bromage scale. RESULTS: There were no significant differences in the onset time of the T10 sensory block, peak level of the sensory block, and onset time of the peak level. The duration of the sensory block was significantly shorter in group 2 than in group 1 (P = 0.017). The duration of the motor block was longer in group 1 than in groups 2 and 3 (P = 0.016, P = 0.04). Pruritus was observed more often in group 3 (37.5%) and shivering was more common in group 1 (P = 0.005). CONCLUSIONS: The addition of fentanyl 10microgram and 20microgram to bupivacaine 5 mg provides adequate anesthesia for elderly patients undergoing urologic surgery with fewer side effects, and fentanyl 10microgram is recommended as outpatient anesthesia.
Subject(s)
Aged , Humans , Analgesics, Opioid , Anesthesia , Anesthesia, Spinal , Anesthetics, Local , Bupivacaine , Fentanyl , Needles , Outpatients , Pruritus , ShiveringABSTRACT
BACKGROUND: Lidocaine blocks sodium channels in nerve membranes, which inhibits sodium influx and prevents development of an action potential. For epidural anesthesia, we usually use lidocaine diluted in normal saline or distilled water. However, diluents containing sodium ions may affect lidocaine activity. METHODS: Fifty patients, ASA physical status class I or II, scheduled for elective epidural anesthesia were randomly divided into two groups.For epidural anesthesia, we used 14 ml of 2% lidocaine solution made with 7 ml of 4% lidocaine plus an equivalent of distilled water (Group DW) or normal saline (Group NS).In the right lateral decubitus position, a 19 G Arrow catheter was inserted 3 cm in the cephalad direction in the L3-4 intervertebral space.In the supine position, 3 ml of 2% lidocaine was injected as a test dose, and the remaining 11 ml of lidocaine was injected 2 minutes later.We used a pinprick test for evaluation of sensory block levels and a Bromage grade for degrees of motor block every 2 minutes during the first 30 minutes. RESULTS: Levels of sensory block were higher in Group DW than Group NS at 12, 14 and 30 minutes. The degree of motor block was also higher in Group DW at 12 and 14 minutes. CONCLUSIONS: Diluent containing sodium ions reduces sensory and motor block compared to sodium-free solution in epidural anesthesia.
Subject(s)
Humans , Action Potentials , Anesthesia , Anesthesia, Epidural , Catheters , Ions , Lidocaine , Membranes , Organic Chemicals , Sodium , Sodium Channels , Supine Position , WaterABSTRACT
BACKGORUND: The relationship among age, height and sensory block height in elderly patients who underwent spinal anesthesia using 0.5% heavy bupivacaine were studied. METHODS: Ninety-seven elderly patients, 65 years of age or older, who were scheduled for spinal anesthesia were divided into four groups. 8 mg of 0.5% heavy bupivacaine was injected in patients who were shorter than 160 cm, and 9 mg was injected in patients who were taller than 160 cm. Then they were further divided into a 65 74 year old group and an older than 75 year old group, and the area of sensory block was compared by the age and height. RESULTS: Sensory block height was not significantly different between the 65 74 year old group and the older than 75 year old group. Height did not correlate with sensory block height in all groups, and the distribution shapes showed variable patterns. CONCLUSiONS: The effect of age and height on the spinal sensory block height in elderly patients is small.