RESUMEN
Background: Regional anaesthesia has come to occupy an important part in clinical anaesthesiology today. As with other fields, regional anaesthesia too has undergone major developments both in techniques and drug availability. Aim: To study and compare the effect of 0.75% Ropivacaine with 0.5% Bupivacaine for epidural anaesthesia in patients undergoing lower abdominal and lower extremity surgeries with respect to the following factors, Onset and Duration of Sensory Block and Onset and Duration of Motor Block. Materials and Methods: To conduct this study, it was decided to consider a random sample of at least sixty (60) patients of either sex between the age of 20-65 years belonging to the American Society of Anaesthesiologists (ASA) physical status I or II scheduled to undergo elective surgery. The study was conducted to compare 0.75% Ropivacaine and 0.5% Bupivacaine for epidural anaesthesia in lower abdominal and lower extremity surgeries across the following parameters; Time taken for the onset of sensory block T12, Time taken for maximum height of sensory block T6, Time C. Geetha, L. Umapradeepa, K. Chandra Prakash, R. Pandu Naik. A comparative study of 0.75% ropivacaine and 0.5% bupivacaine for epidural anesthesia in patients undergoing lower abdominal and lower extremity surgeries. IAIM, 2017; 4(11): 250-258. Page 251 taken for two dermatome segment regression, Time taken for regression up to T12, Time taken for the onset of maximum motor block and Duration of motor block. Results: The onset time for sensory block up to T12 and up to the maximum height of T6 were found to be statistically insignificant; there was no difference in the effect of both the drugs. The two dermatome segment regression and regression up to T12 were statistically significant; it was prolonged in the case of Ropivacaine compared to Bupivacaine. The onset of motor block was statistically significant and was found to be faster in the case of Bupivacaine. The duration of the motor block was also statistically insignificant and it was the same for both the drugs. Conclusion: From these results, this study provides a reasonable ground to conclude that Ropivacaine and Bupivacaine differ in terms of their onset and duration of both sensory and motor block in epidural anaesthesia. Thus Ropivacaine with its higher efficacy, prolonged sensory blockade, lower propensity for motor blockade, proven reduced potential for CNS toxicity and cardiotoxicity, appears to be an important option for regional anaesthesia, management of post-operative pain, labour pain making it the current local anaesthetic drug of choice
RESUMEN
Background: Knowledge and use of adjuvant drug therapy has rendered neuraxial analgesia more effective in the management of both acute and chronic pain conditions. α-2 adrenergic agonists have both analgesic and sedative properties when used as adjuvant in regional anaesthesia. Aim: To study the effects of intrathecal dexmedetomidine added to ropivacaine for surgeries under spinal anesthesia. Materials and methods: This clinical study was conducted on 50 patients of ASA PS 1 and 2 in the age group of 18 -50 years of either sex posted for elective lower limb orthopaedic and lower abdominal surgeries under spinal anaesthesia after taking informed consent, study done over a period of 12 months. Results: All demographic details are insignificant. Average duration of surgery was 94.4 min ± 34.4 min. 76% (n= 38) of subjects belonged to ASA grade 1 and 34% (n=12) subjects belonged to ASA grade 2. Mean duration for onset of Sensory block was 4.12 minutes (SD: ± 1.69) and the mean duration for onset of motor block was 10.12 minutes (SD: ± 2.89). Pulse rate in all the patients was maintained in normal range during the observation period. Mean pulse rate was 76 ±4.3 beats per min. average mean systolic pressure was 117.7 ± 14.3 mm Hg and diastolic pressure 68.7± 4.6 mmHg. Tailam Tanmayee, P. Raghunath, D. Anuradha, R. Pandu Naik. Study of Dexmedetomidine as an intrathecal adjuvant to ropivacaine for postoperative analgesia. IAIM, 2017; 4(11): 241-249. Page 242 Mean values of SBP and DBP were maintained in the study population. However, when considered individually, Hypotension was observed in 3 patients after SAB (Fall in SBP > 20%). The hypotension was mainly observed after 4 to 6 min after SAB. The mean Ramsay sedation scale was 2.08 with SD 0.27. Side effects observed were mainly hypotension, nausea and shivering. Conclusion: To conclude, 5 microgram dexmedetomidine seems to be an attractive alternative as an adjuvant to spinal ropivacaine in surgical procedures, especially those requiring long time. This combination (ropivacaine and dexmedetomidine) provides very good quality of haemodynamic stability. It has excellent quality of postoperative analgesia with minimal side effects.