ABSTRACT
Background: Longer duration of analgesia, ceiling effect on respiratory depression, and the antihyperalgesia property make buprenorphine a good adjuvant for managing moderate-to-severe postoperative pain. Aims: The aim of this study is to evaluate the onset and duration of postoperative analgesia of three different doses of buprenorphine of 60, 100, and 150 µg given intrathecally along with hyperbaric bupivacaine in patients undergoing lower limb surgeries. Setting and Design: This prospective observational study was carried out in the anesthesia department of a tertiary care hospital. Materials and Methods: The study included 90 patients of either sex, aged 18-60 years, scheduled for elective lower limb surgery under subarachnoid block. Patients were randomly allocated into three groups (30 each) receiving different doses of buprenorphine. In addition, all patients received 3 mL of 0.5% hyperbaric bupivacaine. Statistical Analysis Used: The Chi-square test or Fisher's exact test was used to find out the association between the categorical variables. The association of quantitative variables between the groups was assessed by Kruskal-Wallis test while within the groups was assessed by repeated-measures analysis of variance test. Results: Baseline characteristics such as age, gender, and American Society of Anesthesiologist physical status classification were comparable among the three groups. Sensory block, motor block, and total duration of analgesia were significantly higher with higher doses of buprenorphine. The mean difference in the duration of analgesia was comparable in patients receiving 100 µg (720 min) and 150 µg (825 min) of buprenorphine. Bradycardia as a side effect was only in patients receiving 150 µg of buprenorphine. Conclusion: Risk-benefit of different doses of buprenorphine suggests that 100 µg may be the ideal dose for a better quality of spinal block and maintaining hemodynamic stability.
ABSTRACT
BACKGROUND: Intrathecal morphine is commonly used for postcesarean analgesia. Its use is frequently associated with opioid-induced nausea, vomiting, and pruritus. Palonosetron (0.075 mg) combined with dexamethasone (8 mg) is postulated to have an additive effect over each drug alone. The study, therefore, compared the effect of intravenous (i.v.) palonosetron, dexamethasone, and palonosetron with dexamethasone combination in preventing intrathecal morphine-induced postoperative vomiting and pruritus in lower segment cesarean section (LSCS) patients. SETTINGS AND DESIGN: Randomized, prospective, double-blinded, observational clinical study. METHODS: Ninety pregnant women, American Society of Anesthesiologists physical status class I undergoing LSCS were included in the study. They were randomly assigned to three groups - Group P received 0.075 mg palonosetron i.v., Group D received dexamethasone 8 mg i.v., and Group PD received palonosetron 0.075 mg along with dexamethasone 4 mg i.v., just after spinal anesthesia with bupivacaine 2.2 ml (12 mg) and 150 µg morphine. The incidence of pruritus, nausea, vomiting, and need for rescue drug were recorded for 24 h. STATISTICAL ANALYSIS: Statistical analysis was performed using Student's t-test for categorical variables and Chi-square test for noncategorical variables. RESULTS: The incidence of nausea, vomiting was significantly more in Group D (40%) than Group P (27%) and Group PD (20%) in 24 h. The incidence of pruritus was significantly more in Group D (6%) than Group P and PD (3%). The need of rescue antiemetic was more in Group D (30%) than Group P (6%) and Group PD (3%). No difference in three groups requiring rescue antipruritic drug. CONCLUSION: Prevention of intrathecal morphine-induced vomiting and pruritus was more effective with palonosetron alone or with dexamethasone combination than dexamethasone alone. Combination of palonosetron and dexamethasone proved no better than palonosetron alone.
ABSTRACT
BACKGROUND: Bulk of published data support the efficacy of dexmedetomidine for prolongation of peripheral nerve block; but most of the studies are in adults. Ample data regarding use of dexmedetomidine in setting of paediatric peripheral nerve blocks is scarce. AIM AND OBJECTIVE: To determine whether adding dexmedetomidine to ropivacaine in ilioinguinal-iliohypogastric nerve block prolongs postoperative analgesia in children undergoing inguinal hernia repair. MATERIAL AND METHODS: Sixty children of American Society of Anesthesiologist (ASA) grade I - II aged between 2-11 years scheduled for elective hernitomy were randomly allocated to receive an ultrasound guided ilioinguinal-iliohypogastric nerve block (IINB) with 0.2 ml/kg dose of plain ropivacaine 0.2% (group R; n = 30) or ropivacaine 0.2% with adjunct dexmedetomidine 1 µg/kg (group RD; n = 30). Time to first post-operative need for supplemental analgesia triggered by pain score ≥4 according to Children's and infants postoperative pain scale (CHIPPS scale) was the primary end point of study. Number of analgesic doses during first 24 hours; intraoperative hemodynamic changes; sedation; postoperative adverse effects were noted. RESULTS: The mean duration of analgesia was significantly prolonged in group RD (970.23 ± 46.71minutes) as compared to group R (419.56 ± 60.6 minutes). Children in group RD had significantly lower CHIPPS score, and less number of rescue analgesic requirements during first 24 hours postoperatively. No adverse effects were recorded in any group. CONCLUSION: The present study concluded that combined use of ropivacaine and dexmedetomidine in IINB provided profound prolongation of post operative analgesia in children following inguinal hernia repair.
