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Background: Control of post-operative pain is a major concern for the patients and also for the treating physicians. Various analgesic agents such as opioids, nonopioids through various routes such as oral, intravenous, neuraxial, regional for the management of postoperative pain exist. Magnesium has anti-nociceptive properties with additional enhancement of opioid anti-nociception when used epidurally. Materials and methods: The study was a randomized open labelled controlled trail, conducted in the department of anaesthesiology, Govt. Mohan Kumaramangalam Medical College and Hospital, Salem, Tamil Nadu. The data collection for the study was done between June 2016 to June 2017. The study population included people who were undergoing lower limb surgery for various disease conditions. The key outcome variables assessed were highest sensory blockade, time taken for highest sensory level (min), duration of surgery (min), time for regression to L1 (min), duration of analgesia (min). Results: Duration of analgesia was longer in the Magnesium sulphate group, with analgesia lasting for 143.4 +39.57 minutes which was statistically significantly higher compared to Epidural Fentanyl group with 107 (±25.82) minutes. The mean time for regression to L1 was 118 minutes and 119 minutes in group F and FM respectively, there is no statistically significant between two study groups (P value>0.05). There was no statistically significant difference between the groups in the time taken J. Radhika, P. Kayalvizhi. Comparative study of epidural fentanyl and epidural fentanyl with magnesium sulphate for postoperative analgesia in patients undergoing lower limb surgeries. IAIM, 2018; 5(2): 12-19. Page 13 for the highest sensory level (P value>0.05), the duration of surgery and the time taken for the highest sensory level (P value>0.05). Conclusion: Magnesium being a relatively harmless and inexpensive molecule, a non-competitive, Nmethyl-D-aspartate receptor antagonist with its anti-nociceptive properties has a huge role to play in the coming years for postoperative analgesia
RESUMO
Background: There is an on-going quest to know which agent is the better agent for intrathecal anaesthesia for pain relief due to surgical stimuli. Bupivacaine is commonly used local anaesthetic agent for spinal anaesthesia but it has some disadvantages like slower onset of action. Ketamine shows beside its general anaesthetic effect, a local anaesthetic like action. Series of studies have shown a potent analgesia after spinal administration of ketamine alone or in combination with opioids and α2 agonists, suggesting that ketamine alters pain perception at the spinal level. So, the objective of this study to compare the effectiveness of Ketamine action intrathecally with that of bupivacaine in respect to onset & duration of analgesia, onset & duration of motor block, sedation, cardiovascular effects and any other side effects like nausea, vomiting. Materials and methods: In this hospital based prospective comparative study, 100 patients of ASA (American Society of Anaesthesia) I and II scheduled for lower abdominal and lower limb surgery were taken. Patients were divided into two equal groups. Group I – Received 3 ml of hyperbaric bupivacaine (0.5%). Group II – Received 3 ml of hyperbaric Ketamine [taken from 2ml of preservative free ketamine (100mg) added with 2ml of 5% dextrose]. Onset and duration of analgesia, onset and duration of motor block, central effects like sedation, effects on cardiovascular system and any other side effects were compared in both the groups. Analysis data was carried out using the available statistical package of SPSS-20 (Statistical Package for Social Science – version 20 “PASW” statistics). Results: The onset of sensory block and motor block were faster in ketamine group as compared to bupivacaine group. The duration of analgesia was longer in ketamine group as compared to Sunanda Panigrahi, Archana Mhatre. Comparative study between ketamine and bupivacaine intrathecally in lower abdomen and lower limb surgery. IAIM, 2018; 5(8): 47-54. Page 48 bupivacaine group. The duration of motor block was almost equal in both the groups. About sedation, more patients were sedated in ketamine group as compared to bupivacaine group. Patients in ketamine group were more stable cardiovascularly as compared to bupivacaine group. Conclusion: Ketamine can be used as a pure local anaesthetic for spinal anaesthesia with advantage of faster onset of analgesia and motor block as well as longer duration of analgesia. Ketamine group appeared more hemodynamically stable also. So, ketamine can be used as an alternative to bupivacaine for moderate duration of lower abdomen and lower limb surgery despite its central effect like sedation.
RESUMO
Background: Maintenance of the body physiology as near normal as possible during spinal anesthesia is one of the primary goals of the anaesthesiologist. As we know, marked hemodynamic derangements are often seen following subarachnoid block especially in trauma and elderly patients. Neuraxial opioids are not associated with sympathetic nervous system denervation, skeletal muscle weakness or loss of propioception. They predominantly act at the μ receptors present in the substantia gelatinosa of the spinal cord to exert its synergistic analgesic effect more specifically for visceral pain. . Studies have established that opioids and local anesthetics administered together intrathecally have a potent synergistic analgesic effect. Objectives This study was conducted for evaluate the efficacy of low dose hyperbaric bupivacaine plus fentanyl for spinal anaesthesia in the elderly and study the incidence of hypotension in the compared groups.1 Methods: This was prospective study carried out on 60 patient posted for elective lower limb orthopedic surgeries during the period 2010-2011 at civil hospital gandhinagar.The study population was randomly allocated to two groups; Group A - 15mg of 0.5% bupivacaine & Group B - 10mg of 0.5% bupivacaine and 25μg of fentanyl. Results: After analyzing the results of our study we find that systolic B.P. decreased in both the groups, maximum fall occurredat 15 to 20 min in both the groups: decreases were more severe in group A than in group B,(P<0.O5).heart rates were better maintained in group B than in group A. thus group B showed better hemodynamic stability. group b had lesser duration of motor blockage without significantly compromising the duration of sensory block or the operative conditions. none of the patients required intraop anesthetic supplementation. 3 patients in group B had pruritus while none of the patients developed respiratory depression. Conclusion: subarachnoid block with 2cc bupivacaine 0.5% and 25μg fentanyl is a safer and better option, both in terms of maintaining hemodynamic stability and lower incidence of complications without compromising the surgical conditions, for elderly patients undergoing lower limb surgeries.