A Comparative Evaluation Of Dexamethasone As An Adjunct To Bupivacaine And Levobupivacaine For Supraclavicular Brachial Plexus Block Using Peripheral Nerve Stimulator

Background:Dexamethasone appears to be effective in prolonging the duration of analgesia from supraclavicular brachial block using levobupivacaine or Bupivacaine. Long acting local anaesthetic, Bupivacaine is associated with cardiac and central nervous system toxicity which prompted the researchers to develop new local anaesthetic agent with a profile similar to bupivacaine but avoiding the toxic effects. Therefore, the aim of the present study is to test the hypothesis that adding dexamethasone significantly prolongs the duration of analgesia for levobupivacaine and bupivacaine and the magnitude of the effect differs among the two local anaesthetics. Methods: A prospective, randomized study was undertaken at JN Medical College. 120 patients posted for upper limb surgeries under Supraclavicular Brachial Plexus Block were assigned into four groups, each containing 30 patients. Group I received 25 ml Bupivacaine 0.5% and 2ml NS. Group II received 25 ml of Bupivacaine 0.5% and 2ml dexamethasone(8mg) .Group III received 25 ml of Levobupivacaine 0.5% and 2ml NS. Group IV received 25 ml of Levobupivacaine 0.5% and2ml dexamethasone (8mg). Results:Dexamethasone significantly prolonged the duration of analgesia of both levobupivacaine and bupivacaine. Conclusion:Dexamethasone prolongs analgesia in supraclavicular blocks using either levobupivacaine or bupivacaine. Considering the less cardiotoxic profile of levo-bupivacaine it should be preferred over bupivacaine.

Does Ropivacaine Causes less Spinal Induced Hypotension than Bupivacaine in Caesarean Section: A Randomised Study.

Introduction: Hypotension during spinal anaesthesia remained one of the most common complications since decades. Various factors such as posture, fluid status, and characteristics of local anaesthetic affect the overall incidence of hypotension in a parturient. This study was conducted to compare the incidence of spinal induced hypotension with 0.75% isobaric ropivacaine-fentanyl and 0.5% hyperbaric bupivacaine-fentanyl combination. Methods: 80 ASA I & II parturient were randomly divided into two groups to receive either 10 mg hyperbaric bupivacaine(0.5%)+ 25 μg fentanyl(BF) or 15 mg isobaric ropivacaine(0.75%)+ 25 μg fentanyl(RF).The sensory and motor block characteristics, haemodynamic parameters as well as any adverse effects were recorded. Results: Sensory block onset time was 4.5±1.2 min in BF v/s 6.6±1.8 min in RF group. Time to achieve maximum cephalad spread was 8.9±1.5 min in BF v/s 12.6±2.2 min in RF. Onset of motor block was significantly faster in group BF (2.6±1.3 min in BF v/s 5.1±1.3 min in RF). Time to first analgesic requirement was 243.8±20.1 min in BF v/s 236.3±12.4 min in RF. Haemodynamic parameters were more stable in RF. Conclusion: Intrathecal isobaric Ropivacaine-fentanyl combination is a suitable option for caesarean section as it shows less incidence of hypotension with adequate analgesia.

A Prospective Randomised Study to Evaluate the Effects of Clonidine and Fentanyl as Premedication for Intraoperative Haemodynamic Stability in Patients Undergoing Laparoscopic Cholecystectomy.

Background: Laparoscopic surgeries are commonly done in patients suffering from cholelithiasis. However, laparoscopic surgeries are associated with pneumoperitoneum, increased intra-abdominal pressure and insufflation of carbon dioxide leading to altered haemodynamic stability. We conducted a prospective randomised study to evaluate the effects of Clonidine and fentanyl in premedication for intraoperative haemodynamic stability in patients undergoing laparoscopic cholecystectomy. Methods: 70 patients of either sex posted for elective laparoscopic cholecystectomy were included for our study. All patients were randomised using computer generated program and divided into two groups; Group F (35 patients): received Inj. Fentanyl (2 μg/kg IV) 5 minutes prior to induction of anaesthesia, whereas Group C (35 patients) received Inj. Clonidine (1 μg/kg IV) at the similar time before induction of anaesthesia. Haemodynamic parameters (heart rate, mean arterial pressure) of all patients were assessed prior to premedication, before induction, following laryngoscopy and intubation and after pneumoperitoneum. Results: The baseline mean heart rate and mean arterial pressure between Group C was found to be statistically insignificant on comparing with Group F. However, the mean heart rate after intubation, after creation of pneumoperitoneum and after extubation was observed to be statically significant between Group F and Group C (p=0.001). Similar statistical significance was observed between fentanyl group and Clonidine group after premedication and after intubation. Conclusion: Both Clonidine and fentanyl as a premedication had effectively attenuated intraoperative haemodynamic responses but the role of Clonidine was observed to be more appreciable.

Clonidine or Butorphanol as an Adjuvant to Epidural Bupivacaine in Orthopaedic Surgery – A Comparative Analysis of the Quality & Duration of Anaesthesia.

Background: The study was conducted to compare the quality and duration of block by addition of either clonidine or Butorphanol as an adjuvant/additive to epidural bupivacaine in orthopaedic surgical patients. Methods: 75 patients of either sex of ASA status I &II, between 20-60 years of age undergoing orthopaedic surgery were selected for the study. Patients were randomly divided into three groups of 25 each. Group I received 0.5% Bupivacaine (15ml) with 50 μg Clonidine in (1ml), Group II patients, received 0.5%Bupivacaine (15ml) with 1 mg Butorphanol (1ml) and Group III patients received 0.5% Bupivacaine (15ml) with Normal Saline (1ml). The hemodynamic parameters as well as quality of block including onset, completion and regression of motor block were observed. Parametric data were compared using analysis of variance (ANOVA). Inter group comparison was done using unpaired t-test, and chi square test. Results were expressed as mean ± SD and p< 0.05 was considered statistically significant. Result: The demographic profile was comparable among the three groups. Onset of analgesia was significantly early in butorphanol (9.08±2.58 min) group, followed by clonidine (10.6±2.5min) and control group. Duration of analgesia was longest in butorphanol group, followed by clonidine and control group. Height of sensory block achieved was comparable in the three groups (p>.05). Four hour postoperative pain score was significantly lower in butorphanol group as compared to clonidine and control group<0.05.Conclusion: The quality as well as block duration can be enhanced safely by addition of butorphanol as an additive to bupivacaine; butorphanol having an edge over clonidine for the same.

Severe laryngospasm following LMA removal: Questionable role of symptomatic treatment for Upper Respiratory Infection: A case report.

We present a case of life threatening laryngospasm following LMA removal in an asymptomatic infant with past history of watery nasal discharge, relieved of his symptoms by nasal drops. Child was operated for hernia under general anaesthesia with spontaneous ventilation on LMA with an uneventful intra-operative course.

Comparison of ramosetron and ondansetron for control of post-operative nausea and vomiting following laparoscopic cholecystectomy.

Background: Post-operative nausea and vomiting (PONV) is common. 5HT 3 receptor antagonists are commonly used drugs for its prevention. A study was designed to compare the efficacy and safety of ramosetron and ondansetron in patients undergoing laparoscopic cholecystectomy (lap chole). Materials and Methods: A prospective randomized case controlled study was conducted at J. N. Medical College Hospital, Aligarh Muslim University, Aligarh, India, in patients who underwent lap chole following intravenous administration of ondansetron (4mg) or ramosetron (0.3mg) at the end of surgery, and efficacy as well as side effects of ondansetron and ramosetron was documented and compared. Results: One hundred and thirty adult females undergoing lap chole were studied - 65 patients in each of the two groups. In first 24 h after surgery, complete response (No PONV) was observed in 28 patients of the ondansetron group and in 32 patients of the ramosetron group (P>0.05). Complete response in the second 24 h after surgery was observed in 30 patients of the ondansetron group and in 45 patients of the ramosetron group (P<0.05). During the first and second 24 h, PONV requiring rescue antiemetic was significantly higher (P<0.05) in the ondansetron group as compared to the ramosetron group. Adverse drug effects in the post-operative period were observed in 11 and 8 patients in ondansetron and ramosetron groups respectively (P>0.05). Conclusion: Ramosetron was found safe and more effective antiemetic than ondansetron in patients undergoing lap chole.