Résumé
Background: Subarachnoid block is commonest anaesthetic technique used for most gynaecological surgeries. Local anaesthetic agents have traditionally been used for this, but with the discovery of opioid receptors in spinal cord in substantia gelatinosa. Possibility of synergism between opioids & local anaesthetics co-administered intrathecally has been explored for various lower abdominal surgeries. Aims & Objective: To study was to compare effect of intrathecal bupivacaine with bupivacaine, fentanyl mixture to assess safety and efficacy, peri –operative hemodynamic stability postoperative pain relief in major gynecological surgeries. Materials and Methods: 60 female patients with American society of anaesthesiologists (ASA) grade I OR II were divided in two groups after matching. Group BF received inj. Bupivacaine 15 mg (0.5%) 3 ml + inj. Fentanyl 25 mcg, (50 mcg/ml), 0.5 ml and Group B: (inj. Bupivacaine 15 mg (0.5%) 3 ml + Normal Saline (0.5 ml), total volume was 3.5 ml in each group. Spinal anaesthesia was given with conventional technique. Results: Duration of sensory block and effective analgesia was prolonged while there was no change in duration of motor block with intrathecally bupivacaine with fentanyl as compared to inj. Bupivacaine alone. Conclusion: Intrathecal Fentanyl as an adjuvant to bupivacaine improves quality of block with longer duration of sensory block & prolongs duration of effective analgesia.
Résumé
Background: Background & objectives :To study the effect of dexmeditomidine as an adjuvant to bupivacaine in brachial plexus block on onset and duration of sensory and motor block, duration of analgesia, level of sedation,perioperative hemodynamic parameters and complications. Methods: fourty patients of ASA Ι and ASA ΙΙ scheduled for upper limb surgery were included in double blind randomised comparison of inj. Dexmeditomidine and inj. Normal saline. We divided patients in two groups. Group A patients were given inj dexmeditomidine 50 microgm (0.5ml) and group B patients were given inj normal saline in brachial plexus block. We recorded time of onset and duration of sensory and motor block, level of sedation, duration of analgesia, hemodynamic changes and side effects in both groups. Results: mean time to onset of sensory block was 7.42±1.39 min in group A and 8.24± 1.35 min and that of motor block was 15.1± 2.6min in group A and 17.0± 2.9min in group B.Total duration of sensory block was 722.15±78.27min in group A and 360.62±61.7min in group B and that of motor block was 600.6± 54.46min in group A and 300.4± 54.26min in group B. Duration of analgesia was 970.36 ± 80.7 min in group A and 480±40.31 min in group B. Conclusion: addition of 50 microgm of inj dexmeditomidine to bupivacaine in brachial plexus block shortens onset and prolongs duration of sensory and motor block, prolongs duration of analgesia and decreases intraoperative requirement of sedatives.