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Background: The study was to compare intrathecal isobaric ropivacaine and hyperbaric bupivacaine in terms of onset of sensory block, maximum height of sensory block, total sensory duration, onset of motor block, degree of motor block and duration of motor block, quality of anesthesia. Methods: The 100 cases of ASA II undergoing elective lower segment caesarean section were taken for the study and divided into two groups. Group B patients received 2 ml of hyperbaric bupivacaine intrathecally. Group R patients received 2ml of isobaric ropivacaine intrathecally. Patients were evaluated for onset and duration of sensory block, onset and duration of motor block, maximum height of sensory block, quality of anaesthesia, time to request for analgesia, hemodynamic parameters and side effects if any were studied. Results: There were no significant differences between the two groups in mean time to onset of sensory block. Maximum sensory height attained in group B ranged between T4 and T6, where as in group R, it ranged between T2 and T6 which was clinically and statistically highly significant (p<0.001). Total duration of sensory block in group B and in group R, which is not significant (p=0.068). Mean time onset of motor block was 4min in group B and 8 min in group R, (p<0.001). Duration of motor block was 155.20±14.95 min in group B and 94.10±8.31 min group R, which is clinically and statistically significant (p<0.001). Conclusions: Ropivacaine 15 mg (2 ml of 0.75% isobaric ropivacaine) provides comparable quality of sensory block but has slower onset and significantly shorter duration of motor block compared to bupivacaine.
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Resumen: Introducción: La buprenorfina en la anestesia multimodal intratecal ofrece buena eficacia anestésica en histerectomías, pero por el mal entendimiento de su farmacocinética su efecto no está bien descrito. Objetivo: Evaluar la eficacia anestésica de la buprenorfina en la anestesia multimodal intratecal en histerectomías abdominales. Material y métodos: Ensayo clínico, controlado, aleatorizado, doble ciego, en mujeres programadas para histerectomía abdominal, distribuidas en tres grupos: grupo BBMD: buprenorfina 150 μg + bupivacaína hiperbárica 0.15% 4.5 mg + morfina 150 μg + dexmedetomidina 7.5 μg; grupo FBMD: fentanilo 50 μg + bupivacaína hiperbárica 0.15% 4.5 mg + morfina 150 μg + dexmedetomidina 7.5 μg; y grupo BM: bupivacaína hiperbárica 0.42% 12.5 mg + morfina 150 μg. Se evaluó la eficacia anestésica previo a la incisión, durante la disección de la pared abdominal, al ingreso a cavidad abdominal, en la entrada de compresas a cavidad abdominal, en la salida de compresas de cavidad abdominal y en el postquirúrgico inmediato. Resultados: Se analizaron 108 mujeres. Los tres grupos tuvieron muy buena eficacia anestésica; sin embargo, al salir compresas, antes de la dosis peridural y en el postquirúrgico inmediato, el grupo BM fue el que tuvo más molestias (p = 0.004, 0.01 y 0.01, respectivamente). Conclusión: La anestesia multimodal con BBMD demostró muy buena eficacia anestésica.
Abstract: Introduction: Buprenorphine in intrathecal multimodal anesthesia offers good anesthetic efficacy in hysterectomies, but due to the misunderstanding of its pharmacokinetics its effect is not well described. Objective: To evaluate the anesthetic efficacy of buprenorphine in intrathecal multiomodal anesthesia in abdominal hysterectomies. Material and methods: Controlled, randomized, double-blind clinical trial in women scheduled for abdominal hysterectomy, divided into three groups: BBMD group: buprenorphine 150 μg + hyperbaric bupivacaine 0.15% 4.5 mg + morphine 150 μg + dexmedetomidine 7.5 μg; FBMD group: fentanyl 50 μg + hyperbaric bupivacaine 0.15% 4.5 mg + morphine 150 μg + dexmedetomidine 7.5 μg; and BM group: hyperbaric bupivacaine 0.42% 12.5 mg + morphine 150 μg. Anesthetic efficacy was avaluated prior to the incision, during dissection of the abdominal wall, upon entry into the abdominal cavity, upon entry of compresses into the abdominal cavity, upon exit of compresses from the abdominal cavity, and in the immediate postoperative period. Results: 108 women were analyzed, the 3 groups had very good anesthetic efficacy, however, when the compresses come out of the cavity, the BM group had the most discomfort (p = 0.004). Conclusion: Multimodal anesthesia with BBMD demostrated very good anesthetic efficacy.
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Background: Double blinded study involving intrathecal hyperbaric bupivacaine (1.5 ml) with adjuvants as Fentanyl and Buprenorphine Methods: Sixty-six females posted for lower segment caesarean section under spinal anesthesia were randomized into two groups-A and B. Group A received 1.5 ml of hyperbaric Bupivacaine and 0.5 ml (75 µg) of Buprenorphine. Group B received 1.5 ml of hyperbaric Bupivacaine and 0.5 ml (25µg) of Fentanyl. Sensory blockade, motor blockade and duration of analgesia were evaluated. Randomization was done using randomization.com program with GraphPad Quick Cals. Statistical analysis was performed with Statistical Package for the Social Sciences (SPSS) statistics version 28 software. Results: There is no statistical difference in the demographic profiles of both groups. Duration of analgesia(minutes) in group A=255.37±34.63 and in group B=175.43±23.58 with p<0.001. Conclusions: A significant drop in mean arterial pressure in both groups from preoperative values throughout surgery, (p<0.05) with the exception of MAP at 50 minutes in B (p=0.139). A significant increase in heart rate at 2 and 4 minutes in group A when compared with baseline HR (p<0.05). In group B, a significant increase only at 2 minutes post spinal anesthesia, p=0.002. Forty-three patients had hypotension (28 vs. 15), p=0.008. Nausea is higher in Group A than B (26 vs. 4). The difference in sensory level of blockade is statistically insignificant, p=0.62. The difference in time of onset of motor blockade of Bromage score 1 was statistically insignificant, p=0.093. Duration of analgesia (minutes) in group A=255.37±34.63 and in group B=175.43±23.58 with p<0.001.
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Background: Many prior studies have utilized thoracic or lumbar spinal anesthesia with isobaric/hyperbaric bupivacaine or Ropivacaine and opioids for laparoscopic cholecystectomy and have reported variable results. our study is centered around addressing the occurrence of intraoperative right shoulder pain and its potential impact on the need for conversion to general anesthesia.Methods: This is a prospective comparative case series study in which 70 patients scheduled for elective laparoscopic cholecystectomy were. Patients in Group R received 1 ml (1 mg) of Hypobaric Ropivacaine 0.1% at T10-11 followed by 25 mcg fentanyl, and 5 mg Isobaric Ropivacaine 0.5% whereas patients in Group B received 1.5 ml (7.5 mg) Isobaric levo Bupivacaine 0.5% and 25 mcg fentanyl at T8-T10. Patients in both the groups were compared for incidence of shoulder tip pain and Hemodynamic stability.Results: Both techniques achieved satisfactory anaesthesia quality, with similar results in surgical anaesthesia onset. Average surgical duration was 45-75 minutes with average of 60 mins with longer durations in two cases common to both the groups. In group R there was there was no bradycardia or hypotension recorded more than 10% of preinduction vitals. Whereas in group B 2 patients had bradycardia and hypotension more than 10% of preinduction vitals. Conclusions: The T10-11 technique using low-dose (6 mg) hypobaric ropivacaine and isobaric Ropivacaine appears to be superior in terms of shoulder tip pain, and hemodynamic stability compared to the T8-T10 technique using isobaric levo-Bupivacaine alone in higher dose.
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Bupivacaine is a long-acting local anesthetic widely used clinically,but its 6-8 hours duration is insufficient for postoperative analgesia.Designing drug dosage forms to prolong the action time of local anesthetics is the research content of local anesthetics.In 2011,the FDA approved a bupivacaine liposome preparation based on DepoFoam TM technology:Exparel,which can be used for more than 72 hours.This article reviewed the clinical safety research of Exparel and the research progress of its application in clinical postoperative analgesia.
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@#Objective To explore the application value of ultrasound-guided use of bupivacaine for subarachnoid block in hip replacement surgery for elderly femoral neck fractures.Methods A total of 108 elderly patients who underwent hip replacement surgery at Ganzhou Traditional Chinese Medicine Hospital from March 2020 to March 2022 were selected as the study subjects.They were divided into conventional anesthesia group and ultrasound guided anesthesia group by means of random number table,54 cases in each group.Patients in the conventional anesthesia group received routine general anesthesia;Patients in the ultrasound guided anesthesia group received unilateral lumbar anesthesia with bupivacaine under ultrasound-guided guidance.Compare the effectiveness of two anesthesia methods during surgery.Results Compared with the conventional anesthesia group,the anesthesia effect of the ultrasound guided anesthesia group was better(P<0.05);The surgery time,amount of bleeding during surgery,postoperative recovery time,and length of hospital stay in the ultrasound guided anesthesia group were all lower than those in the conventional anesthesia group(P<0.05).The ultrasound guided anesthesia group performed better in terms of hemodynamic stability,with a smaller range of changes,and significantly lower pain scores at different postoperative time points compared to the conventional anesthesia group(P<0.05).Conclusion In elderly patients undergoing hip replacement surgery,using ultrasound-guided bupivacaine for subarachnoid block can achieve ideal anesthesia and analgesic effects compared to traditional general anesthesia,shorten drug onset time,alleviate pain in elderly patients,maintain hemodynamic stability,and have significant clinical application effects.
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Abstract Introduction: Cardiac arrest or arrhythmia caused by bupivacaine may be refractory to treatment. Apelin has been reported to directly increase the frequency of spontaneous activation and the propagation of action potentials, ultimately promoting cardiac contractility. This study aimed to investigate the effects of apelin-13 in reversing cardiac suppression induced by bupivacaine in rats. Methods: A rat model of cardiac suppression was established by a 3-min continuous intravenous infusion of bupivacaine at the rate of 5 mg.kg−1.min−1, and serial doses of apelin-13 (50, 150 and 450 μg.kg−1) were administered to rescue cardiac suppression to identify its dose-response relationship. We used F13A, an inhibitor of Angiotensin Receptor-Like 1 (APJ), and Protein Kinase C (PKC) inhibitor chelerythrine to reverse the effects of apelin-13. Moreover, the protein expressions of PKC, Nav1.5, and APJ in ventricular tissues were measured using Western blotting and immunofluorescence assay. Results: Compared to the control rats, the rats subjected to continuous intravenous administration of bupivacaine had impaired hemodynamic stability. Administration of apelin-13, in a dose-dependent manner, significantly improved hemodynamic parameters in rats with bupivacaine-induced cardiac suppression (p < 0.05), and apelin-13 treatment also significantly upregulated the protein expressions of p-PKC and Nav1.5 (p < 0.05), these effects were abrogated by F13A or chelerythrine (p < 0.05). Conclusion: Exogenous apelin-13, at least in part, activates the PKC signaling pathway through the apelin/APJ system to improve cardiac function in a rat model of bupivacaine-induced cardiac suppression.
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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.
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Humanos , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Dexmedetomidina/uso terapéutico , Bloqueo del Plexo Braquial , Bupivacaína , Sufentanilo , Extremidad Superior/cirugía , Anestésicos LocalesRESUMEN
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.
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Background: The study aims to evaluate whether instillation of levo-bupivacaine intraperitoneally decreases post-operative pain after laparoscopic gynaecological surgeries, using VAS pain Scale.Methods: Randomized placebo controlled double blinded study conducted at tertiary care hospital in New Delhi. 90 ASA I & II women scheduled to undergo elective laparoscopic gynaecological surgeries. 20 ml 0.5% levo-bupivacaine diluted with 40ml normal saline (total 60ml) intraperitoneally at the end of surgery before closure of ports along with port site infiltration of levo-bupivacaine (3-5 ml) in intervention group and 60 ml normal saline intraperitoneally in control group.Results: Mean pain scores were significantly lower (p<0.01) in the intervention group when compared to the control group for initial 4 hours of the study after that mean pain score was lower in intervention group than control group but it was statistically not significant. The requirement of rescue analgesia was also significantly lesser in intervention group compared to control group.Conclusions: Levo-bupivacaine is an easy, cheap and non-invasive method which provides good analgesia in the immediate postoperative period after laparoscopic gynaecological surgery, without adverse effects, especially in the early postoperative period. This improves patients experience and should be made an integral part of all minimal gynaecological endoscopic surgery.
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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.
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Animales , Ratas , Bupivacaína/administración & dosificación , Técnicas Histológicas/métodos , Anestésicos Locales/administración & dosificación , Fibras Nerviosas/efectos de los fármacos , Análisis Discriminante , Ratas Wistar , Análisis de Componente Principal , Solución Salina/administración & dosificación , Inyecciones , Liposomas/administración & dosificaciónRESUMEN
Background: Obstetric anaesthetists while providing anaesthesia for caesarean sections, provide care for both the mother and the unborn baby. This study was performed to evaluate the adverse effects of spinal anaesthesia for Caesarean section. Methods: The present study is a prospective observational study carried out on 100 full-term, low risk pregnant patients who had caesarean section under spinal anaesthesia at Varun Arjun medical college, Shahjahanpur, U. P., India from January 2022 to December 2022.Results: In our study, 43 (43%) patients were between 26-30 years, 32 (32%) patients were between 31-35 years, 16 (16%) patients were between 36-40 years. The 62 (62%) patients were primigravida while 38 (38%) patients were multigravida. The 66 (66%) patients were delivered by emergency caesarean section while 34 (34%) were delivered by emergency caesarean section. In our study, adverse anaesthetic effects were less. 12 (12%) patients had spinal hypotension, 11 (11%) patients had spinal headache, 10 (10%) patients had pruritus, 9 (9%) patients had shivering, 5 (5%) patients had nausea and vomiting, 4 (4%) patients had less visceral pain and neonatal Apgar score each, 3 (3%) patients had failed regional anaesthesia, 3 (3%) patients had bradycardia while 2 (2%) patients had high spinal anaesthesia, 10 (10%) patients had visceral pain.Conclusions: In our study, combination of bupivacaine and a low dose of fentanyl (0.25 ?g/kg) provided excellent surgical anaesthesia with short-lasting postoperative analgesia. There were very few adverse side effects.
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Background: Laparoscopic cholecystectomy is a minimally invasive surgical procedure for removal of a diseased gall bladder. This technique essentially has replaced the open technique for routine cholecystectomies since the early 1990s. Laparoscopic cholecystectomy has become the gold standard for cholecystectomy in the past decade. Most patients are being discharged on the first or second post-operative day. The aim of the study was to evaluate effect of instillation of intra-peritoneal bupivacaine for pain relief in laparoscopic cholecystectomy. The primary outcome is to evaluate pain scores after this procedure., , Methods: It’s an institutional based, observational and randomised control study was conducted in a patients undergoing laparocopic cholecystectomy with gall bladder disease in KPCMCH between 18-70 years of age. The study period was 12 months (from June 2021 to May 2022). 100 patients were included in this study., , Results: Our study showed that, less number of patients had right shoulder tip pain (in Numerical rating scale) and requirement of rescue analgesia in case compared to control group., , Conclusions: We concluded that instillation of intra-peritoneal bupivacaine reduces pain scores after difficult laparoscopic cholecystectomy.
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Background:Spermatic cord block is a useful technique for providing anesthesiawith scrotal pain and it has been described and published in the urology and anesthesia literature for more than 40 years. Spermatic cord block for inguinal hernioplasty along with spinal anaesthesia avoids the potential risks of neuraxial and general anesthesia and provides long-lasting postoperative analgesia. The aim of this study is to evaluate the postoperative effect of 0.5% Bupivacaine for spermatic cord block along with spinal anaesthesia in inguinal hernioplasty. Methods:This study was carried out in KPC medical college and hospital on 100 patients with ASA physical status I and II, age older than or equal to 18 years undergoing elective open inguinal hernioplasty from September 2021 to August 2022. Patients were randomly allocated into two equalgroups: 50 patients received spermatic cord block after mesh placement by bupivacaine 5 ml (0.5%), and 1ml normal saline (group 1), and 50 patients received 6ml saline injection in spermatic cord. Results:There was no significant difference between the demographic data, patient characteristics, heart rate, mean arterial blood pressure, and oxygen saturation in the studied groups. There was significantly rapid onset and prolonged duration of blockade, significant decrease in visual analog scale score at 6 h and 12 h postoperatively and the amount of rescue analgesia in group 1 respectively. Conclusions:Spermatic cord block in inguinal hernioplasty surgery improves onset of the block, prolongs postoperativeanalgesia and reduces the consumption of of postoperative rescue analgesics.
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Background: The purpose of our study was to compare the level of an adequate block with hemodynamic stability with a low dose of Hyperbaric bupivacaine and a conventional dose of bupivacaine in spinal anesthesia for patients undergoing lower uterine cesarean section in a sitting position. Methods: 60 pregnant patients belonging to ASA I and II undergoing elective cesarean section under spinal anesthesia were studied in this prospective, randomized double-blinded study. First group A (n=30) was given inj. Hyperbaric Bupivacaine 12.5 mg and group B (n=30) were given inj. Hyperbaric Bupivacaine 10 mg. Parameters like time for an adequate level of analgesia, peak sensory, and motor level reached, duration of sensory, motor block, and incidence of complications was noted in both groups. Result: The time of onset of an adequate level of sensory block (T10) and motor block was longer for group B than group A. Duration of sensory block and motor block was slightly more for group A but the duration was sufficient to conclude the surgery. Conclusion: It is concluded that subarachnoid block with inj. Hyperbaric Bupivacaine 10 mg is more hemodynamically stable and a better option for pregnant patients undergoing lower uterine cesarean section under spinal anesthesia
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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.
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AIM: To explore the effect of spinal anesthesia on ventricular arrhythmia and involved mechanisms in myocardial ischemia-reperfusion (MIR) rats. METHODS: The rat MIR model was made by occlusion the left anterior descending coronary artery for 30 minutes and reperfusion for 45 minutes. Bupivacaine (0.05 mL / 100 g, 1 mg / kg) was injected slowly via intrathecal for spinal anesthesia. The electromyelogram at T2 thoracic spinal cord was recorded. Ventricular arrhythmias, cardiac function, myocardial damage were assessed by electrocardiography, echocardiography and TTC or HE staining. RESULTS: MIR reduced left ventricular short-axis shortening (LVFS) and left ventricular ejection fraction (LVEF), caused myocardial histological damage and ventricular arrhythmias, promoted spinal electrical discharge frequency and amplitude in T2 dorsal horn. Spinal injection of bupivacaine could significantly reduce spinal cord electrical activities and eliminate MIR-induced arrhythmias. Moreover, bupivacaine also significantly improved MIR-induced myocardial histological damage and cardiac function inhibition. CONCLUSION: Spinal anesthesia can reduce ventricular arrhythmias induced by MIR. The mechanism may be related to the effect of abolishing spinal nerve excitability.
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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.
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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.
RESUMEN
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 ï± 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 ï± 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