A Comparative Study of Dexmedetomidine versus Nalbuphine Used as an Adjuvant to Chloroprocaine for Daycare Surgeries Performed under Subarachnoid Block.

Backgrounds and Aims: Nalbuphine or dexmedetomidine when used as an adjuvant to local anesthetic agents may alter the characteristics of subarachnoid block. The study aimed to compare the effect of adding these drugs as an adjuvant to chloroprocaine for spinal anesthesia. Settings and Design: This prospective, randomized, double-blind study was conducted at a tertiary care center. Materials and Methods: After obtaining permission from the institutional ethical committee and informed patient consent, patients scheduled for surgeries under subarachnoid block were randomized into three groups of 50 each: Group C: Injection 1% chloroprocaine 40 mg (4 mL) with 1 mL normal saline, Group DC: injection 1% chloroprocaine 40 mg (4 mL) with dexmedetomidine 10 µg diluted to 1 mL in normal saline, and Group NC: injection 1% chloroprocaine 40 mg (4 mL) with nalbuphine 0.4 mg diluted to 1 mL in normal saline. Onset, peak, duration, and time to complete regression of sensory and motor blockade were noted. Side effects, if any, were noted and managed appropriately. Statistical Analysis: Qualitative data were analyzed using Chi-square test and quantitative data were analyzed using Student's t-test and two-sided Mann-Whitney U-test. P < 0.05 was considered statistically significant. Results: Group DC had prolonged time to onset, duration, and complete regression of sensory and motor block compared to Group NC and Group C (P < 0.001). Hemodynamic parameters, sedation score, and side effects were comparable in all groups. Conclusion: Thus, nalbuphine is a better adjuvant to chloroprocaine than dexmedetomidine when administered intrathecally for daycare surgeries performed under spinal anesthesia.

Tuberculous Meningitis Presenting as Cerebral Salt Wasting Syndrome: A Review of Literature with Clinical Approach to Hyponatremia.

Hyponatremia in the neurocritical care patients is commonly encountered in the setting of either syndrome of inappropriate ADH secretion or cerebral salt wasting. However, differentiation of SIADH and CSW is paramount in view of their divergent treatment strategies.

Dexmedetomidine as an adjuvant to bupivacaine in caudal analgesia in children.

CONTEXT: Postoperative pain management is becoming an integral part of anesthesia care. Various techniques of pediatric pain relief have been designed among which the most commonly practiced is caudal epidural block. Several adjuvants have been used to prolong the duration of caudal analgesia such as clonidine, neostigmine, ketamine, opioids, and ephedrine. We have designed the study using dexmedetomidine as an adjuvant to assess analgesic efficacy, duration of postoperative analgesia, hemodynamic stability, postoperative sedation, and any adverse effects in children. AIMS: The aim is to study the effects of dexmedetomidine as an adjuvant to bupivacaine in caudal analgesia in pediatric patients posted for infraumbilical surgeries. SETTINGS AND DESIGN: This is a randomized, double-blind study in which effect of dexmedetomidine is studied when added to bupivacaine in the caudal epidural block. The observations are made intraoperatively for hemodynamic stability and postoperatively for the duration of analgesia. SUBJECTS AND METHODS: This study was conducted in 100 children of American Society of Anesthesiologists physical status I and II, aged 2-10 years, undergoing elective infraumbilical surgeries. They were divided into two groups as follows: Group A: (0.25%) bupivacaine 1 ml/kg + normal saline (NS) 1 ml. Group B: (0.25%) bupivacaine 1 ml/kg + 1 µg/kg dexmedetomidine in 1 ml NS. As this study was double-blind, patients were randomly assigned to receive either (bupivacaine + saline) or (bupivacaine + dexmedetomidine) in each group. The patients were observed for hemodynamic stability, respiratory depression, and postoperative pain using face, legs, activity, cry, consolability (FLACC) pain scale for 24 h postoperatively. STATISTICAL ANALYSIS USED: Unpaired Student's t-test. RESULTS: The mean duration of effective analgesia in Group A patients was 4.33 ± 0.98 h versus 9.88 ± 0.90 h in Group B patients. Likewise, the difference in mean FLACC score of both the groups was also statistically significant, 7.21 ± 0.76 and 6.49 ± 1.72 in Group A and Group B, respectively. CONCLUSION: Dexmedetomidine as adjuvant to Bupivacaine increases duration of caudal analgesia and improves hemodynamic stability without an increase in adverse effects in children undergoing infraumbilical surgeries.