RESUMO
Background: The changing trend from an inpatient to outpatient has urged us to use short-acting local anesthetic with adjuvantssuch as opioids to intensify sensory block without affecting sympathetic blockade in spinal anesthesia. This study was designedto compare the safety and efficacy of 25 µg fentanyl as an adjuvant to either 10 mg levobupivacaine or 40 mg chloroprocaineintrathecally.Materials and Methods: In this prospective, randomized, clinical trial, 60 patients of 18–60 years were randomly divided into twogroups of 30 each, to receive either 4 ml of 1% chloroprocaine (40 mg) plus 25 µg fentanyl (Group C) or 2 ml of 0.5% isobariclevobupivacaine (10 mg) plus 25 µg fentanyl (Group L) intrathecally. Patients were monitored for 24 h for sensory and motor blockcharacteristics as a primary outcome and post-operative analgesia, hemodynamics, and side effects as a secondary outcome.Results: Onset of sensory block and time to maximum sensory block were rapid in Group C (2.53 ± 1.20 min and 4.40 ± 1.45 min)as compared to Group L (4.43 ± 1.12 min and 8.10 ± 0.83 min) (P < 0.001). The maximum sensory block was T4 in Group C and T6in Group L. Maximum Bromage score was 2 in both groups but achieved earlier in Group C as compared to Group L (P < 0.001).Duration of sensory and motor block was significantly prolonged in Group L (264.47 ± 29.97 min and 173.80 ± 31.47 min)as compared to Group C (101.50 ± 10.30 min and 75.93 ± 10.41 min). The total duration of analgesia was also prolonged inGroup L (259.83 ± 29.60 min) as compared to Group C (96.50 ± 9.84 min). Patients remained hemodynamically stable and nosignificant side effects and complications were noted.Conclusion: Chloroprocaine provides adequate duration and depth of surgical anesthesia for short procedures with theadvantages of faster block resolution.
RESUMO
Background: Infra-umbilical surgeries may be performed under local, regional (spinal or epidural) or general anaesthesia, spinal block is still a first choice, because of its rapid onset, high quality of blockade, lack of catheter related infection, less failure rate and also cost effective but the duration of block and postoperative analgesia is limited. The purpose of study was to compare the efficacy of adding ketamine to 0.5% hyperbaric bupivacaine with midazolam to 0.5% hyperbaric bupivacaine in elective infraumbilical procedures.Methods: A randomized, single blinded, clinical study. 60 subjects were enrolled from the patients presenting for elective infraumbilical surgeries after following the inclusion and exclusion criteria laid down for the study. Sixty ASA Grade I and II patients undergoing infra umbilical surgeries were randomly divided into one of the two equal groups (n=30).Results: Total 60 patients were included in this study. The mean time to achieve T10 sensory level and modified bromage scale III was prolonged in group M (4.33±1.09, 6.66±1.26 min) as compared to group K (3.3±0.7, 4.96±1.21 min) which was statistically significant (P value <0.05).Conclusions: The present study concludes that addition of intrathecal midazolam to hyperbaric bupivacaine provide very good and prolonged post-operative analgesia without significant intra-operative and post-operative side effects compared to intrathecal ketamine.