Comparison of nebulisation 0.75% ropivacaine with 2% lignocaine for attenuation of haemodynamic response due to intubation: A prospective randomised study.

INTRODUCTION: Laryngoscopy and intubation are associated with the reflex response of hypertension, tachycardia and other intraoperative complications. Nebulised route drug administration and entropy-guided induction enable optimal intubating conditions. AIMS: To compare pre-induction nebulisation between 0.75% ropivacaine and 2% lignocaine in blunting the nasotracheal intubation response. MATERIALS AND METHODS: A total of 100 patients undergoing elective faciomaxillary surgeries were prospectively randomised to receive pre-induction nebulisation: 5mL of 2% lignocaine (100mg) (Group L) or 5mL of 0.75% ropivacaine (37.5mg) (Group R). Patients were induced and intubated (nasotracheal) with entropy monitoring. Observed parameters included systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, entropy at baseline, induction, intubation, post-intubation one, three and five minutes, propofol induction dose, electrocardiogram changes and peri-intubation cough reflex. RESULTS: Ropivacaine aerosol proved significantly better than lignocaine aerosol on haemodynamics (systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate) and cough reflex (p < 0.05). Both groups experienced similar entropy changes and propofol induction dose requirements and no fresh electrocardiogram changes (compared with the baseline). CONCLUSION: Pre-induction nebulised ropivacaine offers superior intubating conditions than lignocaine regarding haemodynamic response and cough reflex for faciomaxillary surgeries.

Comparison of fentanyl and nalbuphine as adjuvants to intrathecal 0.5% bupivacaine in lower limb surgeries: A randomised double-blind prospective study.

INTRODUCTION: Local anaesthetics used in spinal anaesthesia have a limited duration of action. To prolong postoperative analgesia, adjuvants, mainly opioids, are used. As µ agonist drugs have side effects, other receptor agonists are considered. Nalbuphine is a safe and effective kappa agonist adjuvant. AIM: To compare the analgesic efficacy between fentanyl and nalbuphine adjuvants added to 3 mL of 0.5% intrathecal hyperbaric bupivacaine. MATERIALS AND METHODS: This prospective, double-blind, comparative study was conducted in 60 patients of either sex belonging to the American Society of Anesthesiologists classes I and II aged 18-65 years undergoing lower limb surgery with entropy monitoring, randomly allocated into two groups. Group F (n = 30) received 0.5% hyperbaric bupivacaine (3 mL) + 25 µg (0.5 mL) fentanyl. Group N (n = 30) received 0.5% hyperbaric bupivacaine (3 ml) + 0.8 mg (0.5 mL) nalbuphine intrathecally. Hemodynamics, entropy, motor and sensory block characteristics, and complications were noted. RESULTS: The nalbuphine group had a significantly longer two-segment regression time of sensory blockade and extended analgesia duration than the fentanyl group. Haemodynamics, entropy, time for onset of sensory and motor blockade and adverse effects were comparable in both groups. CONCLUSION: Nalbuphine prolongs sensory blockade and postoperative analgesia duration with minimal side effects and is a safe intrathecal adjuvant.