Comparative study of atienuation of needle prick pain of spinal anaesthesia by local infiltration analgesia versus EMLA skin patch

Introduction: Needle prick pain is a distressing event for a pa?ent receiving spinal anaesthesia. A ‘Needle piercing the spine’ might be physically and mentally trauma?zing for many pa?ents. This may lead to unwanted panic and anxiety during the procedure of spinal anaesthesia. To avoid this distressing needle prick pain, many clinicians have resorted to the prac?ce of giving injec?ons of local anaesthe?c or local applica?on of EMLA cream or patch at the site of spinal puncture beforehand for anaesthe?zing the skin and subcutaneous ?ssues. Methods: A prospec?ve cohort study was done. Those enrolled pa?ents were assessed by an expert anesthesiologist, who was not part of the research team, and he prescribed pa?ents either EMLA cream or regular standard lignocaine infiltra?on anaesthesia and labelled them as Group E and Group L respec?vely. The pain score was assessed using a Visual Analogue Scale. Result: A total of 64 pa?ents were enrolled in the study33 in Group E and 31 in Group L. Both groups had an almost similar number of pa?ents who had a similar extent of surgery. Univariate analysis showed that the mean pain score (VAS) was significantly higher in Group E pa?ents compared to that in Group L, p<0.001. The mul?variate analysis had similar findings a?er controlling confounding factors in mul?ple regression analysis. Conclusion: Local 2% lignocaine injec?on achieved significantly more pain reduc?on during spinal needle inser?on compared to the applica?on of an EMLA patch before spinal anaesthesia.

Evaluation of Risk Factors of Postoperative Urinary Retention in Male Patients Undergoing Surgery Under Spinal Anaesthesia : A Prospective Study

Background : Postoperative Urinary Retention (POUR) is common after regional anaesthesia with a reported incidence between 5% and 70%. POUR can lead to significant morbidity with additional surprise and mental trauma to the patient when unwarned. This study aimed to assess the occurrence of POUR in male patients undergoing Surgery under Spinal Anaesthesia and to study the risk factors related to it. Methods : 692 male patients were analysed prospectively for the need for catheterisation which was defined as 搕he inability to void in the immediate Postoperative period with accompanying discomfort and a palpable Bladder.� All such patients were catheterised as an emergency. A record was made about the mean age, surgical condition, comorbidities, duration of Surgery, use of intra-operative sedatives, intra-operative fluid infused and International Prostate System Score (IPSS). Results : The overall mean age of patients with POUR was 46 years. The incidence of POUR was highest among Perianal Surgeries ie, 52/70 (13%) followed by Hernia Surgeries, 18/70 (6.3%). An appreciable reduction was observed in urinary retention after administration of intra-operative sedatives (p=0.022) and lower IPSS (p=0.001). Factors such as age, intra-operative fluid administration, duration of Surgery and previous history of Diabetes did not reach statistical significance as being predictive of urinary retention. Conclusion : An IPSS greater than 7 increases the risk of Postoperative Urinary Retention while the use of intraoperative Sedative in combination with Spinal Anaesthesia decreases the risk. In high-risk patients undergoing perianal procedures, pre-operative patient counselling about the possibility of Postprocedure retention is recommended.

Preoperative assessment of inferior vena cava collapsibility index by ultrasound is not a reliable predictor of post-spinal anesthesia hypotension

Abstract Background Post-spinal anesthesia hypotension is of common occurrence, and it hampers tissue perfusion. Several preoperative factors determine patient susceptibility to hypotension. This study aimed to assess the effectiveness of the Inferior Vena Cava Collapsibility Index (IVCCI) for predicting intraoperative hypotension. Methods One hundred twenty-nine adult patients who were scheduled for elective surgical procedures after administration of spinal (intrathecal) anesthesia were included in the study. Ultrasound evaluation of the Inferior Vena Cava (IVC) was done in the preoperative area, and the patients were shifted to the Operating Room (OR) for spinal anesthesia. An independent observer recorded the change in blood pressure after spinal anesthesia inside the OR. Results Twenty-five patients developed hypotension (19.37%). Baseline systolic blood pressure and mean blood pressures were statistically higher in those patients who developed hypotension (p= 0.001). The logistic regression analysis for IVCCI and the incidence of hypotension showed r2 of 0.025. Receiver Operating Characteristic (ROC) curve analysis demonstrated the Area Under the Curve (AUC) of 0.467 (95% Confidence Interval, 0.338 to 0.597; p= 0.615). Conclusions Preoperative evaluation of IVCCI is not a good predictor for the occurrence of hypotension after spinal anesthesia.

To Compare the effect of Chloroprocaine and Chloroprocaine with Fentanyl for Spinal Anaesthesia: A Prospective Randomised Double Blind Study.

Background: Usually for lower abdomen and lower limb short surgical procedures, spinal anaesthesia is a reliable and safe anaesthesia technique.2-chloroprocaine (2-CP) is an amino-ester local anaesthetic with a very short half-life. Adjuvants are required with short acting local anaesthetic for spinal anaesthesia to prolong analgesia. Aims and Objectives: The present study was conducted to analyse the effect of 2-CP alone and with fentanyl combination in spinal anaesthesia for short surgical procedures in terms of onset of block, adequacy of anaesthesia, analgesia and recovery. Materials and Methods: The study was conducted in our hospital in 60 patients undergoing lower abdomen and lower limb short surgical procedures under spinal anaesthesia with either 2-CP or 2-CP and fentanyl (group I or group II) after randomisation into two groups. Spinal anaesthesia characteristics of sensory and motor block, duration of analgesia were noted and appropriate statistical analysis was performed. Results: The onset of sensory and motor block was faster in group II[5.00 ± 3.19 vs 7.156 ± 3.38 min. (p= 0.0138) and 8.03 ± 5.65 vs 11.03 ± 3.97 min. (p= 0.021)] than in group I, and duration of effective analgesia was prolonged in group II (147.63 ± 40.71 vs 130.40 ± 50.85 min with p value of 0.0002)as compared to group I. Eleven patients in group I required analgesic supplementation in the intraoperative period. Conclusion: The patients undergoing short surgical procedures of lower abdomen and lower limb under spinal anaesthesia with short acting local anaesthetic 2-CP with fentanyl as an additive provides rapid onset of sensory and motor block and prolonged duration of analgesia.

Anesthetic Management of A Patient with Hypertrophic Cardiomyopathy Posted For Non朇ardiac Surgery � Case Report

Hypertrophic cardiomyopathy (HOCM) is a complex cardiac disorder of genetic origin. Though the patients may be asymptomatic the stress of surgery and anaesthesia is known to exacerbate the left ventricular outflow tract (LVOT) obstruction leading to catastrophic complications. We hereby report a successful anaesthetic management of a patient with left intertrochantric fracture diagnosed with HOCM. Careful and meticulous strategies to prevent LVOT obstruction led to entire uneventful introperative and perioperative course.

Troubleshooting obstetric spinal anaesthesia at district hospital level

Obstetric spinal anaesthesia is routinely used in South African district hospitals for caesarean sections, providing better maternal and neonatal outcomes than general anaesthesia in appropriate patients. However, practitioners providing anaesthesia in this context are usually generalists who practise anaesthesia infrequently and may be unfamiliar with dealing with complications of spinal anaesthesia or with conversion from spinal to general anaesthesia. This is compounded by challenges with infrastructure, shortages of equipment and sundries and a lack of context-sensitive guidelines and support from specialised anaesthetic services for district hospitals. This continuous professional development (CPD) article aims to provide guidance with respect to several key areas related to obstetric spinal anaesthesia, and to address common concerns and queries. We stress that good clinical practice is essential to avoid predictable, common complications, and hence a thorough preoperative preparation is essential. We further discuss clinical indications for preoperative blood testing, spinal needle choice, the use of isobaric bupivacaine, spinal hypotension, failed or partial spinal block and pain during the caesarean section. Where possible, relevant local and international guidelines are referenced for further reading and guidance, and a link to a presentation of this topic is provided.Keywords: anaesthesia; resource-limited settings; emergency surgery; obstetric spinal anaesthesia; anaesthetic complications; caesarean section.

Spinal Anaesthesia for Caesarean Section in a Morbidly Obese Parturient: A Case Report

The population of obese individuals is increasing worldwide.Maternal obesity is an important risk factor in pregnancy and problems such as difficulty in endotracheal intubation, risk of aspiration, and hypoxia may occur 2 during generalanaesthesia.A 28-year-old woman (height 1.6 m, body weight 126 kg, BMI 49.2 kg/m ) visited GCS Hospital, Ahmedabad for selective caesarean section at a gestational age of 37 weeks. Patient was diagnosed with PIH. Spinal anaesthesia was selected because of the high possibility of endotracheal intubation failure due to super morbid obesity.Considering the possibility of hypotension, an arterial cannula was placed in the right radial artery for invasive arterial pressure monitoring. After sterile preparation, spinal anaesthesia was performed through the L3–4 interspinous space using a 90 mm 24-gauge spinal needle. During surgery,Blood pressure was maintained between 160/88 and 86/38 mm Hg and heart rate was maintained between 70 and 104 beats/min. The surgery was completed uneventfully. The block level of spinal anaesthesia was maintained at the T8 dermatome level during the operation and was also confirmed at the end of operation.

An Observational Comparative Study to Assess the Block Characteristics of Intrathecal Buprenorphine and Clonidine When Added to Bupivacaine for Orthopaedic Lower Limb Surgeries

Postoperative analgesia enables faster rehabilitation, improves the patient's level of satisfaction, and reduces hospital stay. Regional anaesthesia is the most common anaesthetic technique used for orthopaedic surgeries across the world. Adjuvants are often administered along with a local anaesthetic during spinal anaesthesia to prolong intraoperative and postoperative analgesia. The main objective of this study was to compare the effect of 60 mcg buprenorphine with that of 30 mcg clonidine when added to 3.2 ml bupivacaine with respect to onset and duration of sensory and motor block, maximum level of sensory block, duration of analgesia, and side effects if any.METHODSAfter obtaining institutional ethical committee clearance, a prospective observational study was conducted among 88 participants undergoing orthopaedic surgery of lower limb. Spinal anaesthesia was given, under aseptic precautions with 0.5% bupivacaine heavy 3.2 ml along with either 60 mcg buprenorphine (0.2 ml) or clonidine 30 mcg (0.2 ml). The buprenorphine receiving patients (n=44) were under group A and the clonidine receiving patients (n=44) were under group B. The heart rate, blood pressure, sensory block level, and duration of analgesia, were recorded.RESULTSAnalysis of the data shows that the use of clonidine significantly prolonged the duration of analgesia compared to buprenorphine. The incidence of hypotension, bradycardia, nausea and vomiting, etc. were similar in both groups.CONCLUSIONSUse of 30 mcg clonidine as an adjuvant in spinal anaesthesia provides significant prolongation of analgesia (mean duration of analgesia 190.5 minutes) compared to 60 mcg buprenorphine (mean duration of analgesia 157.5 minutes) without causing any increased incidence of adverse effects.

Gynaecologic Laparoscopic Surgery Using Spinal Anaesthesia - A Retrospective Observational Study

Laparoscopy is traditionally done under General Anaesthesia (GA) with endotracheal intubation. As the number of cases of laparoscopy increased over the years, regional anaesthesia has been quite frequently used for laparoscopy.METHODSA total of 495 cases of laparoscopic surgeries done in the age group 12 to 47 years during the period August 2015 till September 2019 was considered. Spinal anaesthesia was administered with 25G spinal Needle at L4-L5 intervertebral space with 3-4 ml bupivacaine (0.5%, heavy) and the surgeries were completed. The segmental level achieved was T-6. Intra-abdominal pressure after CO2 insufflation for pneumoperitoneum was maintained at 10-12 mmHg. Post-operative monitoring was done.RESULTSOnly 15 cases (3%) required midazolam. 2 patients stayed for >48 hrs post-surgery (0.4%). 4 GA cases required immediate analgesic infusion. In SA cases, analgesic was required almost 2-3 hours after the surgery was over. Onset of bowel sounds was early with SA cases. In the 4 GA cases (0.8%) PONV was noted. Two patients (0.4%) had spinal headache. 6 patients experienced post laparoscopic shoulder pain (1.21%).CONCLUSIONSSpinal Anaesthesia provides a good field for gynaecologic laparoscopic surgery with excellent muscle relaxation, decreased surgical bed oozing, and a rapid return of gut function, good post-operative analgesia, and decreased incidence of PONV than GA.

Evaluation of the Efficacy of Intravenous Ketamine on Prevention of Hypotension During Spinal Anaesthesia in Patients with benign Prostatic Hyperplasia

introduction: Hypotension is a common complicationduring spinal anaesthesia. The elderly patients due toreduced physiological reserves are more prone to developadverse effect of hypotension. Hypotension followingspinal anaesthesia is caused by paralysis of pre-ganglionicsympathetic fibers resulting in decrease systemic vascularresistance, decrease pre-load, decrease after-load, decreasestroke volume, decrease cardiac output resulting in decreaseblood pressure. Current study aimed to evaluate the effectsof intravenous ketamine on prevention of hypotension duringspinal anaesthesia.Material and Methods: Ninety (90) patients aged 50 to70 yrs. (ASA I-II) undergoing surgery for Benign ProstaticHyperplasia were randomly allocated to two groups – GroupK receiving i/v ketamine and Group B without i/v ketamine.After securing i/v line, infusion started with R/L. Followingspinal anaesthesia, ketamine was administered in the dose of.5 mg/kg b.w. to patients belonging to Group K.Results: In both groups, spinal anaesthesia resulted inreduction in Mean Arterial Pressure (MAP). MAP was lowerin the group without ketamine than in the ketamine group atall times. There was a significant change in heart rate in thecontrol group compared to ketamine group (p<0.05).Conclusion: We concluded that ketamine .5 mg/kg b.w.given intravenously just after spinal anaesthesia resulted ingreater hemodynamic stability in elderly patients undergoingtransurethral resection of prostate compared with controlgroup.

A Comparative Study of Intrathecal 0.5% Hyperbaric Bupivacaine & Intrathecal 0.75% Isobaric Ropivacaine in Lower Abdominal Surgeries

Ropivacaine, a long acting amide local anaesthetic, has reduced potential for neurotoxicity and cardiotoxicity and is considered to block sensory nerves to a greater degree than motor nerves. In today’s world, faster recovery along with minimal side effects and early ambulation after surgeries under spinal anaesthesia are very important. So, this prospective randomized study was aimed at evaluating and comparing the efficacy and safety of intrathecally injected isobaric ropivacaine and intrathecally injected hyperbaric bupivacaine in patients posted for lower abdominal surgeries under spinal anaesthesia.METHODS90 patients belonging to ASA physical status I & II scheduled for lower abdomen surgeries were randomly selected for the study and were divided into two groups of 45 each. Group B received 3 ml of 0.5% hyperbaric (15 mg) bupivacaine intrathecally. Group R received 3 ml of 0.75% isobaric (22.5 mg) ropivacaine intrathecally. Onset and extent of sensory block, onset and duration of motor block, maximum height of sensory block, duration of analgesia, hemodynamic parameters and adverse effects if any were studied. SPSS 20.0 and GraphPad Prism 6.0 were used for the analysis of the data.RESULTSThe mean time for onset of sensory block was significantly faster in group B as compared to group R (8.28±2.2 min v/s 7.98±2.2 min). There was no significant difference between the groups regarding the time for two segment regression. Mean time of onset of motor block was significantly faster in group B. The mean duration of motor blockade was 146.89±14.11 min in group R and 208.91±14.62 min in group B. The mean duration of analgesia was comparable in both the groups. Hemodynamic parameters and side effects were comparable in both the groups.CONCLUSIONS0.75% isobaric ropivacaine provided similar duration of analgesia with a shorter duration of motor block as compared to hyperbaric 0.5% bupivacaine and it also provided adequate level of sensory block for the surgery with minimal intraoperative and postoperative side effects and stable haemodynamics throughout the surgery.

Comparison of Hemodynamic Response and Vasopressor Requirement Following Spinal Anesthesia between Normotensive and Hypertensive Women Undergoing Elective Cesarean Section

Introduction: Spinal anesthesia (SA) is the technique of choice in cesarean sections, but it is not widely accepted in hypertensiondue to fear of sudden and extensive sympathetic blockade. Sympathetic blockade induced hypotension may occur in up to64–100% of pregnant women who have been given spinal anesthesia for cesarean delivery, especially when hyperbaric solutionsare used. Severely pre-eclamptic patients were previously believed to be at high risk of severe hypotension, with maternaland fetal consequences because of reduced plasma volume and because of the need to limit i.v. fluids to avoid iatrogenicpulmonary edema.Methodology: The present study, “comparison of hemodyanamic response and vasopressor requirement following spinalanesthesia between normotensive and hypertensive women undergoing elective cesarean section” 100 women of age20–35 years, the American Society of Anesthesiologists physical Status Ι and ΙΙ carrying a singleton pregnancy and scheduledto have elective cesarean section in Netaji Subhash Chandra Bose Medical College, Jabalpur, were enrolled into two groups.GroupA: 50 were normotensive women and Group B: 50 were hypertensive women. All patients received a standard subarachnoidblock under all aseptic precautions with 12.5 mg 0.5% hyperbaric bupivacaine.Results: Based on the data from our study, it could be concluded that after spinal anesthesia in patients undergoing electivecesarean section-hypertensive group of parturients had less fall in mean systolic blood pressure (SBP), diastolic BP, and meanarterial BP in comparison to normal healthy pregnant women which were statistically significant (P < 0.05). Hypertensive group ofpatients required less ephedrine to treat hypotension in comparison to normotensive patients which were statistically significant(P < 0.05). The incidence of hypotension was almost 7 times less in hypertensive parturients than healthy parturients (oddsratio = 23.14, relative risk of hypotension in Group A = 7.2, confidence interval = 7.6–70.3).Conclusion: To summarize, our results showed that hypotension following SA administered for cesarean section wassignificantly less in hypertensive patient than in healthy pregnant women. In addition, vasopressor requirements were also lessin hypertensive parturients and neonatal outcome was comparable between the two groups. Therefore, subarachnoid blockis an acceptable technique to perform in hypertensive parturients due to its virtue of simplicity, rapidity, cost-effectiveness,and intensity of block.

Effect of Intravenous Dexmedetomidine on Spinal Anaesthesia with Hyperbaric Bupivacine.

Background: Spinal anaesthesia is one of thecommonest anaesthetic techniques for infra-umbilicalsurgeries. Administration of dexmedetomidine forsedation during spinal anaesthesia is found to prolongthe duration of block. Aim and Objectives: To evaluating the effect of intravenous dexmedetomidine onblock characteristic of spinal anaesthesia withhyperbaric bupivacaine. Material and Methods: Atotalof 120 patients scheduled for various elective surgeriesunder spinal anaesthesia with hyperbaric bupivacainewere included in the study. The patients were dividedinto two groups of each containing 60 subjects. GroupD received 1µg/kg bolus dexmedetomidine over 10minutes immediately after spinal anaesthesia followedby 0.5µg/kg/hr infusion till the end of surgery andGroup S received similar amount of saline. Datacollected include onset of sensory and motor blockade,time for two segmental regression of block, duration ofanalgesia and sedation score were noted. Results:Onset of sensory block was faster in group D(2.38±1.48 min) as compared to Group S (3.03±0.22min). Onset of motor block was significantly faster inGroup D (6.97±0.93 min) as compared to Group S(8.01±0.85 min). Time required for two segmentregression was prolonged in Group D (122.67±7.15min) as compared to Group S (65.76±4.71 min). Totalduration of analgesia was also prolonged in group D(4.29 ±1.04 hr) compared to Group S (2.24±0.29 hr).Conclusion: Intravenous administration of dexmedetomidine prolongs the duration of sensory and motorblockade with arousable sedation.

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.

A Study between Lumbar Epidural and Spinal Anesthesia in Elective Caesarean Section in Rural Women in Bangladesh

Objective: Present study was conducted to evaluateeffectiveness of lumbar epidural and spinal anaesthesia inelective caesarean section.Methods: This experimental study is conducted at tertiarymedical college hospital, Gopalgong. Written informed consentfrom 100 patients were obtained for this experimental study.Purposive sampling technique was used.Results: During the study, where in group-A 52.02% womenwere in their first pregnancy followed by 28.28% were 2ndpregnancy, 19.7% were multi gravid women. where in group-A,35% had hypotension where as in group-B it was 11%. groupA, 30% patients were Highly satisfied where as in group-B itwas 65%. The patients selected for the study was divided intotwo groups: Group – I (Spinal): 50 Patients selected, Group – II(Epidural): 50 patients selected.Conclusion: From our result and study we can conclude that,continuous epidural technique which allowed mother earlybreastfeeding and ambulation. Further studies are needed forbetter outcome.

A comparative study of intrathecal bupivacaine and levobupivacaine for patients undergoing caesarean section

Background: The present study was conducted to compare the effects of 0.5% isobaric levobupivacaine and 0.5% hyperbaric bupivacaine in pregnant females undergoing caesarean section.Methods: Study was conducted on 100 pregnant females undergoing caesarean section. They were randomly divided into two groups B and L receiving 2 ml of 0.5% hyperbaric bupivacaine and 0.5% levobupivacaine respectively. Two groups were compared with regard to sensory block, motor block, haemodynamic stability and complications if any.Results: Time to achieve sensory blockade till T6 dermatome was prolonged in group B (162.52±80.55 sec) as compared to group L (139.40±49.79 seconds) (p value= 0.087). Prolonged duration of motor blockade was observed in group B (160.76±6.56 minutes) as compared to group L (131.48±14.42 minutes) (p<0.001). Less haemodynamic stability was seen in patients of group B with more incidence of hypotension and bradycardia.as compared to group L.Conclusions: Levobupivacaine is nearly equally effective to bupivacaine to produce sensory and motor blockade with comparable onset time and better haemodynamic stability with lesser side effects.

Comparative evaluation of subarachnoid block with low dose bupivacaine and fentanyl versus low dose bupivacaine and sufentanil in patients undergoing inguinal surgeries

Background:Fentanylis a phenylpiperidine derivative synthetic opioid agonist. As an analgesic fentanyl is 75-125 times more potent than morphine. Sufentanil is a semisynthetic thienyl analogue fentanyl with analgesic potency 5 to 10 times more than that of fentanyl. Recently there has been an interest in using analgesics and localanaesthetics in an attempt to decrease the local anaestheticdose enabling fasterrecovery.Methods:A double blinded randomised study was carried out with 50 patients of ASA grade I and II aged between 20 and 60 years undergoing elective inguinal and below inguinalregionsurgeriesunder low dose spinal anaesthesia. Patientsreceived 10 mg of 0.5% hyperbaric bupivacaine with 50 μg of fentanyl added to a total volume of 3 ml(group F),and with sufentanil 5 μg [diluted with 5% dextrose] and volume made to 3 ml(group S). Postoperative VAS score for pain, duration of motor block and complications postoperatively is noted.Results:Prolonged postoperative analgesia was observed in group F (216.7min) and group S(264.8)which was statistically significant among the groups (p<0.001) is higher in group S and also duration of motor block in group F(130.6) and group S (90.5) which was statistically significant among the groups (p<0.001) which is higher in group F than group S. Conclusions: When compared to intrathecalbupivacaine-fentanyl combination; intrathecal bupivacaine-sufentanil combination provided prolonged postoperative analgesia with a lesser duration of motor blockade thus allowing early post operative ambulation

Post Dural Puncture Headache (PDPH) - A Prospective Study in Tertiary Care Hospital in Solan District (HP)

Spinal Anaesthesia is widely practiced anaesthetic technique for sub - umbilical surgical procedures. However the technique is not without complications and Post Dural Puncture Headache (PDPH) remains important amongst such complications. Aims and Objectives: The present study was prospective , was conducted to study the overall incidence of PDPH using 26 G Quincke type spinal needle and to establish its relations( if any) with the age of patient, type of surgery and time to ambulate following the surgery. Methods: A total of 500 patients of ASA I and II were studied. These patients underwent various orthopaedic, general surgical, obstetrical/ gynaecological surgical procedures under Spinal Anaesthesia using 26 G Quincke type spinal needle. All the patients were followed upto 72 hours post operatively for evaluation of PDPH. Results: The incidence of PDPH in the present study was 1.6%. The incidence was higher in female patients (75%). Among the female patients, 50% of patients were those who underwent Caesarean Section. Conclusion: The present study concludes free and widespread use of 26 G Quincke type needle in all patients who require Spinal Anaesthesia irrespective of type of surgery

Comparison of thoracic vs lumbar spinal anaesthesia fo orthopaedic surgeries

Background: Thoracic spinal anaesthesia has emerged as one of the most promising anaesthetic techniques in the recent times. On the other hand, lumbar approach has been the conventional choice  for orthopaedic surgeries since the advent of spinal anaesthesia. This study aimed at determining which approach is better suited for orthopaedic surgeries.Methods: Total 60 patients scheduled for orthopaedic surgeries were divided into two groups : group T and group L. Group T patients were given thoracic  spinal anaesthesia at the T9-T10 / T10-T11 interspace using  1.5 ml of hyperbaric bupivacaine 0.5% (5 mg/ml) + 25µg (0.5 ml) of fentanyl.  Group L patients received  2.5 ml of  hyperbaric bupivacaine 0.5% (5 mg/ml) + 25 µg (0.5 ml) of fentanyl at LI-L2/L2-L3 interspace. Authors evaluated the degree of analgesia  and  motor block,  haemodynamics  and neurological complications.Results: Onset of analgesia was faster in thoracic group - 2min. The duration of sensory  and motor block was shorter in thoracic group. There were no significant differences in haemodynamic variables and respiratory parameters between the two groups  and no neurological complication in any patient.Conclusions: Thoracic spinal anaesthesia is preferable to lumbar spinal anaesthesia for orthopaedic surgeries.

Current Sedation Practices in Procedures under Spinal Anaesthesia (SA)

Introduction: Peri-operative anxiety and stress associated with procedures under Spinal anaesthesia (SA) is common and sedation may help improving compliance of the patient and quality of SA. There is no standard sedation protocol for SA. Study aimed to observe the various sedation protocols practiced in our institute during SA with regard to drugs used and their dosages, sedation levels, effect on the duration of SA and to assess the patient satisfaction level. Material and methods:This was a prospective observational study comprised of patients undergoing elective surgeries under SA. IV sedation was given as per the attending anaesthesiologist’s discretion after SA. We noted hemodynamic parameters, RSS, two-dermatomal regression time, Patient satisfaction scores etc. Epi Info 7.2 software was used for statistical analysis. Results Total 500 patients received Dexmedetomidine (189), Midazolam (301) and Propofol (10) as IV sedation. Mean time required for regression of two-dermatomal sensory levels and for rescue analgesia requirement was prolonged in Dexmedetomidine (121.64, 203.75 mins resp.), as compared to Midazolam and Propofol. Mean Ramsay Sedation Score (2.4- 3) and Patient satisfaction scores (6-7.5) were comparable in all the drugs. Hemodynamic parameters were stable and comparable. No hypotension, respiratory depression seen except bradycardia (HR<50) noted in 4 patients of Dexmedetomidine. Conclusion: Drugs used for sedation in 500 patients were Dexmedetomidine, Midazolam and Propofol. All the drugs provided optimum sedation without respiratory depression with stable hemodynamics and good patient satisfaction. In addition, Dexmedetomidine increased durations of sensory anaesthesia and post-operative analgesia