Search

Introduction: Subarachnoid Block (SAB) is a commonly used technique for lower abdominal surgery. Dexamethasone has been proven effective as an additive when used with bupivacaine. However, there has been no study comparing the analgesic efficacy of dexamethasone with levobupivacaine under SAB. Aim: To compare the analgesic efficacy of levobupivacaine with or without dexamethasone in patients scheduled for lower abdominal surgeries. Materials and Methods: A pilot randomised doubleblind controlled trial was undertaken in the Department of Anaesthesiology, University College of Medical Sciences Guru Tagh Bahudur (UCMS-GTB) Hospital, New Delhi, India on 60 patients with Americian Soceity of Anaesthesiolgy (ASA) grade I or II, aged 18-65 years, undergoing lower abdominal surgeries under SAB from January 2021 to August 2022. In Group LS, 12.5 mg of 0.5% isobaric levobupivacaine (2.5 mL) with normal saline (1 mL) was administered, and in Group LD, 12.5 mg of 0.5% isobaric levobupivacaine (2.5 mL) with 4 mg dexamethasone (1 mL) was given. Patients were assessed for sensory and motor block, haemodynamic parameters, pain score, and side-effects. Unpaired t-tests/Mann-Whitney U tests were used to determine significance. A p-value of less than 0.05 was considered significant. Results: The two groups were comparable in terms of demographic profile. The age in the LS group was 37.80±9.98 years, and in the LD group, it was 38.63±12.37 years. The male-to-female ratio in the LS and LD groups was 17:13 and 21:9, respectively. The weight range in both groups was between 50 to 67 kg. The Basal Metabolic Index (BMI) was 22.40±2.43 kg/m2 and 21.70±2.21 kg/m2 in the LD and LS groups, respectively. All these parameters, including height, had a p-value of more than 0.005, except for the duration of analgesia. The duration of effective analgesia was also longer in the LD group (247.00±36.69 min) than in the LS group (138.50±22.52 min) with a p-value of <0.001. The time of onset of sensory block was 9.13±2.98 minutes in the LD group and 10.30±3.06 minutes in the LS group, which was statistically insignificant. Conclusion: Authors concluded addition of 4 mg (1 mL) of dexamethasone to 2.5 mL of 0.5% isobaric levobupivacaine provides a clinically longer duration of effective analgesia with early onset and better quality of sensory and motor block than 2.5 mL of 0.5% isobaric levobupivacaine alone. Therefore, 4 mg of dexamethasone with 2.5 mL of 0.5% isobaric levobupivacaine is recommended for lower abdominal surgeries under SAB. [ABSTRACT FROM AUTHOR]

Introduction: Subarachnoid Block (SAB) with Hyperbaric Bupivacaine (HB) is the most common anaesthetic technique for Lower Segment Caesarean Section (LSCS). Levo-bupivacaine, an enantiomer of racemic bupivacaine, has been developed to provide anaesthesia with the same effectiveness but with better haemodynamic stability. Aim: To compare the effectiveness of hyperbaric levobupivacaine to HB in achieving sensory and motor blocks in Caesarean Section(CS) using equivalent doses. Materials and Methods: Eighty parturients aged 18-38 years with no co-morbidities were randomly divided into two groups receiving equivalent doses of HB and hyperbaric levobupivacaine for SAB. The effectiveness of the two drugs was compared in terms of the time taken to achieve sensory and motor blocks, as well as the time for block regression for two segments for sensory block and the return of motor block assessed by the ability to flex the ankle joint. Adverse events such as a fall in Systolic Blood Pressure (SBP) and the dose of vasopressor were noted for the two groups. Results: The time taken to attain a T6 dermatomal block level was 2.43±1.00 and 2.80±1.51 (p-value 0.08) for the bupivacaine and levo-bupivacaine groups, respectively. Complete motor block of the lower limb was achieved in 4.85±1.67 and 5.15±1.82 (p-value 0.53). However, the time to 2-segment regression for sensory block was significantly faster in the levo-bupivacaine group than in the bupivacaine group (125.9±28.56 minutes and 109.13±28.84 minutes, respectively, p-value 0.009). Regression from motor block was also found to be highly statistically significant (158.38±34.92 minutes for bupivacaine and 138.75±25.71 minutes for the levobupivacaine group, p-value 0.006). Spinal-induced hypotension was comparable in both groups, but the bupivacaine group needed a much higher repetition of dose of vasopressor than the levo-bupivacaine group. Conclusion: Levo-bupivacaine is comparable to its racemic isomer bupivacaine in achieving anaesthesia when administered Intrathecally (IT) for CS. However, with equivalent doses, the duration of action is significantly shorter with hyperbaric levobupivacaine. Dose adjustment might be required with hyperbaric levo-bupivacaine based on the duration of the surgery. Haemodynamic stability is also similar with both drugs. [ABSTRACT FROM AUTHOR]

Introduction: Spinal anaesthesia is the choice technique for Lower Segment Caesarean Section (LSCS). When using subarachnoid block (spinal analgesia), opioids are employed as the main adjuvants along with local anaesthetics to achieve intra/postoperative analgesia. These opioids have desirable properties such as reducing the dose of local anaesthetics, minimising side-effects, providing analgesia, and prolonging the duration of anaesthesia. Aim: To evaluate and compare the efficacy between intrathecal Buprenorphine and Fentanyl as adjuvants to hyperbaric bupivacaine (0.5%) in women undergoing LSCS under spinal anaesthesia. Materials and Methods: A randomised double-blinded clinical trial was conducted at Bharati Vidyapeeth Hospital and Research Centre in Pune, Maharashtra, India between July 2021 and February 2022. A total of 80 parturients with American Society of Anaesthesilogists (ASA) grade II, aged 18 and older, scheduled for elective LSCS, were randomly divided into two groups of 40 each. Group B received 1.8 mL of 0.5% Bupivacaine with 60 μg Buprenorphine, while Group F received 1.8 mL of 0.5% Bupivacaine with 25 μg Fentanyl. The onset/duration of motor block and sensory block, intraoperative haemodynamics, side-effects, postoperative pain, and demand for the first rescue analgesia were assessed using Chi-square test, Fisher’s-exact probability test, or independent sample t-test. Results: Demographic data such as age, weight, Body Mass Index (BMI), and ASA grade were similar in both groups. The mean duration of surgery in Group B and Group F was 48.12±6.86 min and 48.25±6.56 min, respectively. The mean duration of sensory blockade in Group B was 264.38±37.16 min, and in Group F it was 193.50±34.27 min. The total duration of motor block was 231.00±43.74 minutes in Group B and 171.00±36.87 min in Group F. The total duration of sensory and motor block in Group B was significantly longer (p-value <0.05). The mean time to first rescue analgesia in Group B and Group F was 304.63 min and 228.63 min, respectively (p-value <0.05). Conclusion: The present study concluded that both drugs are safe and suitable as adjuvants with local anaesthetics in spinal anaesthesia for LSCS. The addition of intrathecal buprenorphine to bupivacaine provides a more promising postoperative analgesic effect compared to intrathecal fentanyl, without causing any significant maternal or neonatal side-effects. [ABSTRACT FROM AUTHOR]

Introduction: Postoperative pain management poses a major challenge in patients who undergo lower limb orthopaedic surgeries. Methods that reduce the requirements of systemic analgesics and have minimal adverse effects on haemodynamic stability are the need of the hour. Nalbuphine, a kappa agonist/partial μ antagonist can be utilised in spinal anaesthesia as an auxiliary to local anaesthetic. Aim: To evaluate the efficiency of intrathecal hyperbaric bupivacaine versus nalbuphine plus fentanyl as adjuvants in patients undergoing lower limb orthopaedic surgeries. Materials and Methods: This prospective randomised clinical trial comprised 70 American Society of Anaesthesiologists (ASA) grade I and II patients aged between 18 to 60 years who had been posted for elective lower limb orthopaedic operations. Patients were randomly assigned to either Group NB (intrathecal bupivacaine with nalbuphine) or Group FB (Intrathecal bupivacaine with fentanyl). Onset and duration of sensory and motor block, haemodynamic alterations, side-effects, and requirement for systemic analgesics in the postoperative period were examined. Results: There was no statistically significant difference in beginning of sensory and motor blockage between the two groups. In comparison to group FB, group NB's sensory blockade lasted substantially longer (126.06±6.52 minutes vs. 103.34±3.7 minutes; p-value<0.001). In group NB, the length of the motor block was considerably longer (p-value<0.001). When compared to patients in group FB (230.83±7.98 minutes), patients in group NB experienced analgesia for a mean time of 278.31±9.58 minutes, which was noticeably longer. There was no discernible difference between group NB and group FB (p-value>0.05) in terms of symptoms such as nausea, vomiting, bradycardia, and hypotension throughout the intraoperative period. Conclusion: In patients scheduled for elective lower limb orthopaedic procedures, intrathecal nalbuphine 1 mg as an adjuvant to 0.5% hyperbaric bupivacaine for subarachnoid block extend the duration of sensory block, motor block, and the postoperative analgesia more successfully than intrathecal fentanyl 25 μg. [ABSTRACT FROM AUTHOR]

Introduction: For routine and emergency upper limb surgeries, brachial plexus block is better alternative to general anaesthesia. As compared to classic Interscalene brachial plexus Block (ISB), Low Interscalene Block (LISB) deposit Local Anesthetic (LA) more caudad causing sensory-motor blockade of upper limb. It acts as bridge between supraclavicular and classic ISB. Local anaesthetic mixture are used to shorten the onset of sensorymotor blockade. Alongside, various adjuvants are mixed with LA to further improve quality of block. Aim: To compare the efficacy of dexmedetomidine and clonidine as adjuvants to LA mixture in LISB for upper limb surgeries to assess onset and duration of Sensory-motor block and to observe any complication associated with block. Materials and Methods: This double-blind, randomised prospective clinical study was conducted on 90 patients, aged 18 to 60 years, posted for upper limb surgeries with American Society of Anesthesiologists (ASA) grade I, II at a tertiary care centre of Government Medical College, Patiala, Punjab, India from February 2021 to November 2021. The patients were randomly divided into three groups. Group I: levo-bupivacaine 0.5% (20 mL)+ lignocaine 2% (10 mL)+ Normal Saline (NS) (1 mL), group II: levo-bupivacaine 0.5% (20 mL)+ lignocaine 2% (10 mL) + dexmedetomidine 50 mcg (1 mL), group III: levo-bupivacaine 0.5% (20 mL)+ lignocaine 2% (10 mL)+ clonidine 50 mcg (1 mL). The parameters observed were: onset and duration of sensory and motor block, any intraoperative complication. Data was compiled with the help of MS-Excel and analysis done with IBM Statistical Package for Social Sciences (SPSS) version 22. Results: The mean onset time of sensory and motor block was faster in group II (4.20±0.62, 5.25±0.89 min) as compared to group III (5.24±0.99, 6.23±0.96 min) and group I (6.48±0.87, 7.03±1.02 min). The mean duration of sensory and motor block was prolonged in group II (743.38±12.55, 673.21±22.29 min) as compared to group III (480.65±14.72, 433.03±7.28 min) and group I (311.28±5.75, 272.03±6.09 min). No adverse effect was observed during this study. Conclusion: Dexmedetomidine was more effective than clonidine as an adjuvant to LA mixture (0.5% levobupivaciane + 2% lignocaine) in low interscalene brachial plexus block and no episode of pneumothorax and phrenic nerve palsy was seen. [ABSTRACT FROM AUTHOR]

Introduction: For administering Spinal Anesthesia (SA) 0.5% bupivacaine is employed with Dexmedetomidine (DMT) as an adjuvant. Literature review reveals that either intrathecal or lowdose intravenous DMT can enhance the characteristics of SA with bupivacaine Aim: To evaluate the effect of a single bolus intravenous (i.v.) DMT 0.5 µg/kg given either before or after the SA in combination with intrathecal 0.5% bupivacaine compared with intrathecal bupivacaine plus DMT. Materials and Methods: A randomised, triple-blind, singlecentre and placebo-controlled study was conducted at Gayatri Vidyaparishad Institute of Health care and medical technology, Marikavalasa, Visakhapatnam, Andhra Pradesh, India, from April 2020 to December 2021. Eighty patients were allocated to four study groups of 20 each. Patients of group Intrathecal DMT (ITD) were given SA with 0.5% bupivacaine heavy 3.4 mL+5µg DMT, patients of group Before Spinal DMT (BSD) were given intravenous DMT before administering the SA with bupivacaine, patients of group After Spinal DMT (ASD) were given intravenous DMT after administering the SA with bupivacaine, and the patients of group Nil DMT (ND) or control group, were given SA with 0.5% bupivacaine heavy 3.4 mL. The primary outcome variable was the difference in the duration of analgesia. The secondary outcome variables were the differences in the onset and duration of the block both motor and sensory. Differences of the parametric data were analyzed using Analysis of Variance (ANOVA) and Tukey's Post Hoc test HSD Beta (Honestly significant difference). For analysis of non parametric data Chisquare test was used and a p-value of =0.05 was considered as statistically significant. Results: Patients in the ITD group had a longer duration of analgesia of 280.7±5.0 min (vis-a-vis 215±9.34, 210.7±12.0 and 97.9±7.12 min in BSD, ASD and ND, respectively) with a statistically significant difference at a p-value <0.00001. They had a shorter duration of onset of motor block of 3.4±0.49 (visa-vis 4.6±0.53, 6.09±0.44 and 6.3±0.65 in BSD, ASD and ND groups, respectively) with a statistically significant difference at a p-value <0.00001. Duration of onset of the sensory block was 2.2±0.37 min in the patients of ITD group (vis-a-vis 3.2±4.76, 3.5±6.71 and 4±0.40 in BSD,ASD and ND groups, respectively) with a statistically significant difference at a p-value <0.00001. Conclusion: Dexmedetomidine used as an adjuvant to intrathecal bupivacaine produces greater augmentation of duration of analgesia, earlier onset of sensory and motor block, more haemodynamic stability and fewer overall side effects compared to its intravenous bolus administration. [ABSTRACT FROM AUTHOR]

Introduction: Intravenous regional anaesthesia for forearm and hand surgeries, which is one of the safe, cost-effective and rapid onset anaesthesia is less popular nowadays, because of its lesser postoperative analgaesia and tourniquet pain. Aim: To compare dexmedetomidine and clonidine as an adjuvant to 0.5% lignocaine to study block characteristics, tourniquet pain and postoperative analgaesia in forearm and hand surgeries. Materials and Methods: This randomised clinical trial was conducted in Acharya Vinoba Bhave Rural Hospital (Tertiary Care Hospital), Wardha, Maharashtra, India, from September 2019 to September 2021 on 70 patients posted for forearm and hand surgeries. The patients were divided into two groups of 35 each. Group C received clonidine 1 mcg /kg with 40 mL of 0.5% lignocaine preservative free. Group D received dexmedetomidine 1 mcg /kg with 40 mL of 0.5% lignocaine preservative free. Independent samples t-test was used for evaluation of demographic data, haemodynamic data, block characteristics, duration of surgery and tourniquet, onset of tourniquet pain, duration of analgaesia and intraoperative and postoperative analgesic requirement. results: Onset of sensory and motor block was faster with dexmedetomidine group (1.60±0.60 min and 2.77±0.81 min) when compared to clonidine group (3.57±0.74 min and 6.40±1.26 min). Duration of analgaesia was significantly longer in group D (345.23±44.52 min) compared to group C (205.14±37.76 min), sensory and motor regression was delayed with group D (7.69±0.72 min) as compared to group C (6.40±0.85 min). There was no significant adverse effect noted in both the groups. conclusion: Dexmedetomidine is an excellent adjuvant when added to lignocaine for Intravenous Regional Anaesthesia (IVRA) in terms of block quality, postoperative analgaesia, and adverse effects. [ABSTRACT FROM AUTHOR]

Introduction: Neuraxial opioids are widely used as adjuvants to local anaesthetic as they improve quality and duration of block. Neuraxial opioids like Butorphanol and Fentanyl allow prolonged analgesia in the postoperative period and faster recovery from spinal anaesthesia. Aim: To compare the safety and efficacy of Butorphanol and Fentanyl combined with bupivacaine for spinal anaesthesia in infraumbilical surgeries. Materials and Methods: The present study was a randomised controlled trial in which 110, ASA I and II patients of either sex who underwent elective infraumbilical surgeries under spinal anaesthesia were selected. Patients were allocated randomly into two groups A (n=55) and B (n=55). Group A (F) received intrathecal 0.5% hyperbaric bupivacaine 12.5 mg (3 mL) with fentanyl 25 microgram (0.5 mL) to make it total 3.5 mL. Group B (B) received intrathecal 0.5% hyperbaric bupivacaine 12.5 mg (3 mL) with butorphanol 250 microgram (0.25 mL) and Normal Saline (NS) 0.25 mL to make it total 3.5 mL. Heart Rate (HR), Systolic and Diastolic Blood Pressure (SBP, DBP), two segment regression time of sensory block, motor block were assessed at preset intervals. Chi-square test or Fischer's-exact test were used and a p-value =0.05 was considered as statistically significant. Results: Mean of two segment sensory regression time of Group-A was 41.94±1.73 minutes and Group-B was 50.56±4.43 minutes (p<0.0001). Time to onset of motor block in Group-A was 5.28±.32 minutes and Group-B was 5.27±.32 minutes (p=0.96). Mean duration of motor block in Group-A was 81.23±4.87 minutes and Group-B was 109.83±2.61 minutes (p<0.0001). Time to rescue analgesic was 289.27±7.37 minutes in Group-A and 378.41±10.25 minutes in Group-B (p<0.0001). HR, SBP and DBP were comparable among the groups. Conclusion: Intrathecal bupivacaine-butorphanol mixture was clinically better as it provided longer duration of analgesia with lesser incidences of pruritus and nausea/vomiting compared to intrathecal fentanyl-bupivacaine mixture. [ABSTRACT FROM AUTHOR]

Introduction: Ultrasound guided interscalene block is used for the upper limb surgeries. Various adjuvants have been used for prolonging the local anaesthetic action, without increasing the drug dosage. Aim: To evaluate the effect of magnesium sulphate (MgSO4) as an adjuvant to bupivacaine on onset and duration of interscalene block, haemodynamic parameters, and requirement of postoperative analgesics. Materials and Methods: A total of 60 ASA I and II patients of age group 20-60 years were scheduled for shoulder and arm surgeries. The patients received 20 mL of 0.5% bupivacaine with 0.5 mL of MgSO4 (50%) in Group I and 20 mL of bupivacaine with 0.5 mL saline in Group II for ultrasound guided interscalene block. Onset and duration of sensory and motor block was noted. VAS score, time to first rescue analgesic and total analgesic used in 24 hour were recorded. Results: The demographic profile was comparable (p>0.05). The mean onset of sensory blockade and motor blockade was comparable in both the groups (p>0.05). The duration of sensory blockade was significantly prolonged in Group I (759.93 min) as compared to Group II (568.37 min) (p<0.001). The duration of motor blockade was 350.17 minutes in group I and 300.27 minutes in Group II and the difference was significant (p<0.001). The VAS scores were significantly lower in Group I as compared to Group II (p<0.05). The time to first rescue analgesic and total analgesic used in 24 hours were significantly less in group I (p<0.001). Conclusion: MgSO4 as an adjuvant to ultrasound guided interscalene block significantly improves the quality and duration of the block. [ABSTRACT FROM AUTHOR]

Introduction: Spinal anaesthesia is the preferred technique for most of the lower abdominal surgeries nowadays. Currently, Bupivacaine is the most commonly used drug in spinal anaesthesia. A number of adjuvants have been used to improve postoperative analgesia, along with the bupivacaine. Intrathecal ketamine, which is a N-Methyl D-Aspartate (NMDA) blocker prolongs the duration of postoperative analgesia due to inhibition of dorsal horn. Aim: To assess the duration of postoperative analgesia between two groups i.e., bupivacaine alone and bupivacaine with ketamine and also to assess the intraoperative and postoperative haemodynamic stability, onset and duration of sensory as well as motor block, side-effects of injection ketamine when given intrathecally as an adjuvant with injection bupivacaine. Materials and Methods: A prospective, randomised study was conducted in 60 patients with American society of Anaesthesiologist (ASA) Class I and II aged between 20-60 years posted for elective lower abdominal surgeries under subarachnoid block and were randomly selected and divided into two groups of 30 each. Bupivacaine Group B received intrathecal bupivacaine 12.5 mg (2.5 mL)+1.0 mL normal saline (total volume of 3.5 mL) whereas, ketamine Group BK received intrathecal bupivacaine 12.5 mg (2.5 mL)+1 mL (50 mg) Ketamine (total volume of 3.5 mL). Statistical analysis was done by using descriptive and inferential statistics using chi-square test and Student's t-test. Results: The onset of sensory block was faster in group BK than compared to group B. Duration of sensory block and the time for 1st pain medication was significantly prolonged in Group BK. Haemodynamic parameters were comparatively more stable in Group BK than Group B. Conclusion: Ketamine, when added to bupivacaine intrathecally, decreased onset and prolonged the duration of sensory block. It also prolonged the postoperative analgesia with better haemodynamic stability than bupivacaine alone. [ABSTRACT FROM AUTHOR]

Introduction: For any surgery in the upper extremity that does not involve the shoulder, a supraclavicular block is preferred, as it is a safe procedure associated with rapid onset and reliable anaesthesia. Although ropivacaine has been extensively studied for epidural anaesthesia, very few reports exist on its use in supraclavicular brachial plexus block. Aim: This study was conducted to investigate and compare the effectiveness of supraclavicular brachial plexus anaesthesia with two different concentrations of ropivacaine (0.5% and 0.75%) and to compare them with the standard 0.5% bupivacaine. Materials and Methods: Ninety patients of age 18 to 60 years belonging to American Society of Anaesthesiologists (ASA) status 1 or 2, admitted to Pondicherry Institute of Medical Sciences were chosen for the study and were divided into three groups. Group A received 30 ml of 0.5% bupivacaine, group B received 30 ml of 0.5% ropivacaine and group C received 30 ml of 0.75% ropivacaine into the supraclavicular region, by a nerve-stimulator technique. Onset time of each of the drug was recorded both for the sensory and motor block. Duration of sensory and motor block was recorded along with perioperative haemodynamic monitoring. Results: The onset of complete sensory and motor block observed with both ropivacaine groups and bupivacaine was similar (16.85 ± 6.67 min in group A, 17.79 ± 5.03 min in group B and 18.48 ± 6.14 in group C, p < 0.05); onset of motor block (21.45 ± 4.45 min in group A, 22.23 ± 4.05 min in group B and 22.33 ± 5.17 in group C, p < 0.05). The duration of sensory block with 0.5% bupivacaine was 11.58 hours, with 0.5% ropivacaine was 9.02 hours with 0.75% ropivacaine was 8.87 hours (p<0.001). The duration of motor block with 0.5% bupivacaine was 12.94 hours, with 0.5% ropivacaine was 8.29 hours with 0.75% ropivacaine was 7.89 hours (p<0.001). Multiple comparison test with Bonferroni correction showed there was statistically significant difference in mean duration of sensory block between Group A (0.5% bupivacaine) and Group B (0.5% ropivacaine) and also between Group A (0.5% bupivacaine) and Group C (0.75% ropivacaine). However, there were no statistically significant difference in mean duration of sensory block between Group B (0.5% ropivacaine) and Group C (0.75% ropivacaine). The preoperative, intra operative and postoperative heart rate, systolic & diastolic blood pressure and oxygen saturation were comparable among the three study groups (p>0.05). No side effects were recorded in the study. Conclusion: The onset of sensory and motor block was similar in all the three groups. However, when compared to bupivacaine group, recovery of motor functions was faster in both the ropivacaine groups. Patients in all the 3 groups did not experience any adverse effects. [ABSTRACT FROM AUTHOR]