The efficacy of paravertebral block evaluated by pain-related biomarkers and reactive oxygen species (ROS) following surgery for breast cancer: A randomized controlled study.

Background and Aims: Paravertebral block has been found to be a recommended method of analgesia for breast surgeries. We aimed to assess the efficacy of paravertebral block compared to morphine by means of the visual analogue scale (VAS), pain-related biomarkers, and reactive oxygen species (ROS) in adult patients undergoing breast cancer surgeries under general anesthesia. Methodology: Forty patients undergoing breast surgery with or without lymph outcome were randomly divided into two groups. Group M received general anesthesia with intraoperative injection morphine (0.1 mg/kg) and group P received general anesthesia with paravertebral block with 0.25% bupivacaine (0.3 ml/kg). The primary objective was to compare the postoperative pain using VAS at baseline, 2 hours, 24 hours, and 48 hours. Secondary objectives were to compare the levels of pain-related biomarkers and ROS in both the groups at baseline, 24 hours, and 48 hours and to study the correlation between the VAS and level of pain-related biomarkers and ROS. Results: There was no significant difference in the postoperative VAS scores in both the groups (P = 0.252, 0.548, 0.488 at baseline, 24 hours, and 48 hours, respectively) and no significant difference in the mean biomarkers in both the groups. The mean VAS negatively correlated with biomarker levels at 24 hours and 48 hours, but the change in VAS after 24 hours and 48 hours did not significantly correlate with the change in the biomarkers. Conclusion: Paravertebral block is equally efficacious to intraoperative morphine for breast surgeries for postoperative analgesia. The biomarker levels were not significantly different when patients received paravertebral block or morphine.

A Comparative Study of Analgesic Efficacy of Intrathecal Bupivacaine with Ketamine Versus Bupivacaine with Magnesium Sulphate in Parturients Undergoing Elective Caesarian Sections.

Background and Aims: Spinal anaesthesia is the most preferred technique of anaesthesia in parturient, undergoing lower segment caesarean sections (LSCS) which provides effective pain relief during intra operative and early postoperative period. However, recent studies demonstrate that about 50%-70% of patients experience moderate to severe pain after LSCS indicating that postoperative pain remains poorly managed. The aim of our study was to compare intrathecal magnesium sulphate (Mgso4) and ketamine as adjuvants to hyperbaric bupivacaine in parturients posted for elective caesarean sections under spinal anaesthesia to determine their effectiveness in extending the duration of analgesia. Materials and Methods: After institutional ethical committee approval, 82 parturient undergoing elective LSCS were enrolled into the prospective randomized double blinded study. Group BK (n = 41) received intrathecal ketamine (25 mg) as additive to hyperbaric bupivacaine and group BM (n = 41) received magnesium sulphate (75 mg) as additive to hyperbaric bupivacaine. Time of onset of sensory analgesia, motor blockade, duration of analgesia was noted down. Intraoperative hemodynamics and any adverse effects of study drugs were noted. Results: The mean duration of analgesia in group BK was significantly longer (P < 0.05) than in Group BM. The onset of sensory and motor blockade was significantly early in Group BK compared to Group BM. Hemodynamics was better maintained in Group BK with less requirement of ephedrine compared to Group BM. The visual analog scale scores were significantly lower without side effects in both the groups. Conclusion: The present study demonstrated that the duration, quality of analgesia, hemodynamic stability was better with intra thecal ketamine as an adjuvant to bupivacaine compared to intrathecal MgSo4 without any significant side effects on mother and child.

Comparative evaluation of anaesthetic efficacy and haemodynamic effects of a combination of isobaric bupivacaine with buprenorphine vs. isobaric levobupivacaine with buprenorphine for spinal anaesthesia - A double blinded randomised clinical trial.

BACKGROUND AND AIMS: Bupivacaine is the most frequently used local anaesthetic for spinal anaesthesia, however, use of levobupivacaine in clinical practice has advanced recently. This study aimed to compare the anaesthetic potency and haemodynamic effects of intrathecal bupivacaine with buprenorphine versus levobupivacaine with buprenorphine in infraumbilical surgeries. METHODS: This prospective randomised double blind study was conducted in seventy patients aged 18-65 years, American Society of Anesthesiologists grade I-II, scheduled for lower abdominal and lower limb surgery under spinal anaesthesia. The patients either received 0.5% isobaric racemic bupivacaine 3 ml with 2 µg/kg of buprenorphine (Group B) or 0.5% isobaric levobupivacaine 3 ml with 2 µg/kg of buprenorphine (Group L). The time for onset of sensory block between the two groups was the priomary end-point. Other measurements included haemodynamic variables, sensory and motor blockade characteristics, postoperative analgesia, and complications in the first 24 h. RESULTS: There was no significant difference in the onset of sensory block between the two groups. Sensory and motor blockade characteristics were similar between the two groups. However, there was significant fall in the heart rate at 5 min in Group B compared to Group L. There was statistically significant fall in systolic blood pressure in group B compared to Group L from 5 min up to 60 min and fall in diastolic blood pressure from 10 min to 45 min. CONCLUSION: Our study showed that onset of sensory block is similar between isobaric levobupivacaine with buprenorphine 37 38 and isobaric bupivacaine with buprenorphine.