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Background: Regional nerve blocks are crucial for intraoperative and postoperative pain management, reducing complications linked to general anesthesia. The purpose of this study is to compare the effects of dexamethasone dosages of 2mg & 6mg on sensory & motor block completion periods as well as post-operative analgesic duration in infraclavicular blocks for upper-limb procedures. Methods: Infraclavicular brachial plexus block guided by USG was administered to 34 ASAI and II patients, with 17 patients in each group. 25 ml of 0.5% levobupivacaine and 2 mg dexamethasone were administered to Group A. For the block, Group B received 25 ml of 0.5% levobupivacaine combined with 6 mg dexamethasone. The analysis did not include three of the unsuccessful blocks. After the brachial plexus block, vital parameters were recorded every at 0, 120,150,180, 210 and 240 mins. Postoperatively vitals were recorded at 12 hours, 24 hours and 36 hours. The patient was monitored until the motor and sensory block had regressed completely. Results: The study found that demographic variables and hemodynamic parameters were non-significant in both groups. The mean duration of motor block in group A (2mg) was 1069.38 minutes, significantly lower than group B (6mg) with 1294.07 minutes. Additionally, the mean duration of analgesia in group A (2mg) was 1117.19 minutes, significantly shorter than group B (6mg) with 1418.13 minutes. Conclusion: The study suggests that a 2mg dosage of dexamethasone when combined with 0.5% levobupivacaine, may be a more effective option for infraclavicular brachial plexus blocks due to its ability to provide effective analgesia. [ABSTRACT FROM AUTHOR]

Background: The use of a higher volume of 0.5% bupivacaine, however, is associated with hemodynamic instability. Adjuvants such as morphine and other opioids are added in with the local anesthetic to reduce this adverse effect and extend the duration of sensory block, hence extending the length of analgesia. However, opiates are associated with a high risk of respiratory depression and other side effects. Nalbuphine has been used to counteract these adverse effects. Thus, we decided to compare the analgesic effect of intrathecal (IT) nalbuphine with IT morphine. Aims and Objectives: The aim of the study was to compare IT morphine with nalbuphine as adjuvant to a spinal anesthetic agent. The primary objective was to compare between the time of onset of sensory and motor blockade and the post-operative analgesic duration between the two adjuvants, while hemodynamic variables and side effects were studied as secondary variables. Materials and Methods: This randomized controlled study was conducted after Ethical Committee approval for a period of 1 year on 100 patients who fulfilled the inclusion criteria. They were randomized into two groups to receive sub-arachnoid block: Group A: 3 mL of 0.5% Hyperbaric Bupivacaine and 0.2 mg morphine and Group B:3 mL of 0.5% Hyperbaric Bupivacaine and 0.5 mg nalbuphine. The following parameters were monitored -- Height, Weight, blood pressure, American Society of Anesthesiologists grading, time of onset, maximum duration and regression of Motor and sensory blocks, and total duration of analgesia. Results: The onset of sensory blockade was comparable in both groups while the onset of motor blockade was significantly longer in the morphine group (P≤0.001). The duration of analgesia in the morphine group was longer as compared to nalbuphine group and was statistically significant (P<0.05). The incidence of side effects was 26% in the morphine group and 6% in the nalbuphine group, which was statistically significant (P<0.05). Fourteen patients in the morphine group had pruritus and four patients in the nalbuphine group experienced nausea. Conclusion: IT nalbuphine with 0.5% bupivacaine produces rapid onset of anesthesia and early post-operative analgesia with minimal side effects, but the total analgesic duration was more with IT morphine. [ABSTRACT FROM AUTHOR]

Background: Sub-arachnoid block or spinal anaesthesia is a common mode of anaesthesia that is used for lower limb orthopaedic surgeries. Bupivacaine hydrochloride is a long-acting amide anaesthetic used extensively intrathecally. It has the ability to effectively block sensory and motor pathways. However, it has drawbacks, like cardiotoxicity and neurotoxicity. Ropivacaine is a long-acting amide local anaesthetic agent. It has the capacity to block sensory nerves more than motor nerves. Ropivacaine has reduced potential for neurotoxicity and cardiotoxicity. Fentanyl is a synthetic opioid. It can be added as an adjuvant to local anaesthetic agents used intrathecally. Fentanyl is characterised by its high potency, rapid serum elimination, and minimal histamine release. The blood-brain barrier can be quickly crossed by fentanyl, which takes one to two minutes to generate analgesia. Objectives: To compare post-operative analgesia in patients receiving bupivacaine with fentanyl and ropivacaine with fentanyl in lower limb orthopaedic surgeries via sub-arachnoid block; onset, duration of analgesia, duration of sensory and motor blockade; study the haemodynamic stability of patients in both groups; compare the requirement of 24 hours rescue analgesia; to compare the incidence of side effects. Methodology: This study will be a comparative interventional study which will be conducted on 60 adult patients of both sexes posted for lower limb orthopaedic surgery. They will be randomly divided into two groups with 30 patients in both groups. Group A: Patients receiving bupivacaine 3 mL with fentanyl 25 µg and Group B: Patients receiving ropivacaine 3mL with fentanyl 25 µg. The onset of and duration of block (sensory as well as motor), hemodynamic parameters, post-operative analgesia time and side effects (if any) will be recorded. Trial registration: Submitted to Clinical Trial Registry of India (CTRI) Trial REF/2023/05/067586

Background: To compare the analgesic activity of fentanyl and clonidine combined to Bupivacaine for caesarean section spinal anaesthesia. To compare hemodynamics, post-operative sedation, and newborn outcome. Material and Methods: 150 patients undergoing elective or emergency caesarean section were studied at Area Hospital, Dhone, Nandyal, Andhra Pradesh, India from October 2021 to September 2022. Randomly dividing patients into 3 groups of 50 each for injections. Physiological and demographic data, the start of analgesia, the peak of cephalic spread, the upper level of sensory block, and the grade of motor block were observed during surgery. The additional results' mean and SD were calculated. Statistical significance was determined using Anova tables. Results: Statistics showed that groups' greatest sensory levels were exceedingly highly significant (P 0.001). After five minutes in SBP, there were no significant differences between the three groups (P>0.05). At 15 minutes, group A considerably differed from groups B and C. (P 0.001). B&C, however, did not differ from one another significantly (P>0.05). At 30 minutes, A&B had a considerable difference (P 0.05). Sedation level 1 was associated to groups A and B. The second sedation level was tied to Group C. The aforementioned associations were statistically quite strong (P 0.001). Conclusion: Both intrathecal clonidine and the clonidine fentanyl combination improved the efficacy of intraoperative analgesia. Clonidine and fentanyl together significantly improved the intraoperative analgesic effects and sustained postoperative analgesia compared to clonidine alone. The operating room's hemodynamics were steady. Unexpectedly, the analgesia persisted longer. The medication's synergistic benefits virtually ever resulted in any side effects. The course of the developing foetus was unaltered. [ABSTRACT FROM AUTHOR]

Background: To investigate the effects of fentanyl and Clonidine when combined with bupivacaine during spinal anaesthesia for caesarean sections. To assess the length of analgesia by contrasting two groups. To correlate and contrast the two groups', newborn outcomes, hemodynamic effects and post-operative sedation. Material and Methods: A randomized prospective comparative study was performed at Kamineni Academy of Medical Sciences and Research Centre, LB Nagar, Hyderabad in 90 patients undergoing elective or emergency caesarean section. For medication injections, patients were randomly divided into 3 groups of 30. Physiological and demographic characteristics, the beginning of analgesia, the peak of cephalic spread, the upper level of sensory block, and the grade of motor block as determined by the Bromage motor scale were all observed throughout surgery. The mean and standard deviation of the additional results were calculated. Anova tables were used to assess statistical significance. Results: Groups' highest sensory levels were statistically extremely highly significant (P 0.001). In SBP, Three groups did not significantly differ from one another after five minutes (P>0.05). A significantly differed from groups B and C at 15 minutes (P 0.001). B&C, however, did not significantly differ from each other (P>0.05). A&B had a significant difference at 30 minutes (P 0.05). Groups A and B were connected with sedation level 1. Group C was connected to the sedation level 2. The correlations mentioned above were statistically extremely strong (P 0.001). Conclusion: The effectiveness of intraoperative analgesia was enhanced both by the intrathecal clonidine and the clonidine fentanyl combination. In contrast to clonidine alone, the combination of clonidine and fentanyl dramatically enhanced intraoperative analgesic effects and sustained postoperative analgesia. Hemodynamics within the operating room were stable. The analgesia lasted longer than expected. There were hardly any negative effects brought on by the medications' synergistic effects. The course of the foetus was not changed. [ABSTRACT FROM AUTHOR]

Abstract The aim of this study was to evaluate the latency, extent of analgesia, and duration of motor block of levobupivacaine alone and combined with methadone or dexmedetomidine after epidural administration during and after mastectomy in dogs. Twenty-four mature, mixed-breed female dogs were randomly divided into three experimental groups with eight animals each, according to the agents used in lumbosacral epidural analgesia: levobupivacaine 0.75% alone (1.5mg/kg - control group), levobupivacaine 0.75% (1.5 mg/kg) + methadone 1% (0.3 mg/kg), or levobupivacaine 0.75% (1.5 mg/kg) + dexmedetomidine 0.05% (3 µg/kg). During surgery, cardiorespiratory parameters were evaluated. Rescue analgesia was given when there were signs of nociception and was necessary in all three treatment groups. Since all animals received rescue analgesia during the surgery and immediately post-surgery, the duration of the sensitive block were not evaluated. The extent of sensory block was between the 12º and 13º thoracic vertebrae for the control group, 7º thoracic vertebra to 5º lumbar vertebra (methadone group), and 8º thoracic vertebra to 4º lumbar vertebra for the dexmedetomidine group. Methadone or dexmedetomidine combined with levobupivacaine increased the extent of the sensory block and the duration of the motor block in bitches when administered via the epidural route.

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]

Purpose: Local anesthetics can spread into the subendothoracic fascia compartment via the arcuate ligament and apposition zone of the diaphragm after the anterior quadratus lumborum blocks. Therefore, a new block may be achieved if local anesthetic is administered into the diaphragmatic apposition zone (DAZ) under direct laparoscopic visualization by surgeons. Therefore, we evaluated the sensory loss and postoperative analgesic efficacy of this new block in patients receiving laparoscopic nephrectomy. Methods: A total of 28 patients scheduled to receive elective laparoscopic nephrectomy under general anesthesia were enrolled in this study. The DAZ blocks were performed in patients under direct laparoscopic visualization with 20 mL of 0.5% ropivacaine before the dissected kidneys or renal tumors were taken out from the incision. All patients received the intravenous patient-controlled analgesia after surgery. The dermatomes of sensory loss and the muscle weakness of quadriceps femoris were assessed at 2 h post-surgery in the wards. The postoperative pain was scored. The opioid consumption in the first 24 h after surgery was recorded. Results: The average number of dermatomes of sensory block was 8.6 ± 1.2. The highest level of sensory loss was T6 (T5-T6) [median (interquartile range, IQR)], and the lowest level of sensory block was L1 (L1–L2). The postoperative pain scores at rest or on movement at 2 h, 6 h, 12 h, 24 h and 48 h were kept at the low levels (less than 4). The muscle strength of the quadriceps femoris evaluated was 5 (5– 5) points [median (IQR)]. Total dose of intravenous morphine equivalent consumption in the first 24 h after surgery was 21.2 ± 4.1 mg. Conclusion: The DAZ block manifests a wide dermatomal coverage of sensory loss and is associated with the low levels of postoperative pain intensity and opioid use. It provides a new postoperative analgesia option for patients undergoing laparoscopic nephrectomy. [ABSTRACT FROM AUTHOR]

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Introduction: For administering Spinal Anesthesia (SA) 0.5% bupivacaine is employed with Dexmedetomidine (DMT) as an adjuvant. Literature review reveals that either intrathecal or low-dose 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, single-centre 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+5 μg 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 analysed using Analysis of Variance (ANOVA) and Tukey’s Post Hoc test HSD Beta (Honestly significant difference). For analysis of non parametric data Chi-square test was used and a p-value of ≤0.05 was considered as statistically significant. Results: The mean age of the study participants in group ITD, group BSD, group ASD and group ND was 61.2±9.2, 59.8±10.3, 57.9±10.2, and 60±9.4, respectively. 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

Background: Spinal anesthesia is the most commonly used technique for cesarean section as it is very economical and easy to administer. The short duration of action of local anesthetic drugs has created a matter of concern for anesthesiologists. Aim of the Work: To compare the efficacy of intrathecal dexamethasone with intravenous dexamethasone as an adjuvant to prolong the sensory block obtained by spinal anesthesia and postoperative analgesia in cesarean section. Participants and Methods: 66 pregnant women scheduled for cesarean section were randomly allocated to one of three groups including (22) patients each. All the patients received injection of heavy bupivacaine 0.5% 10 mg through spinal anesthesia, with adding 1 mL of 0.9% saline and normal saline 2 mL intravenously (control group), or 0.5 mL (2mg) dexamethasone diluted in 0.5 ml of 0.9% saline intrathecally with normal saline 2mL intravenously (IT group ), or dexamethasone 2mL (8mg) intravenously with intrathecal injection of heavy bupivacaine 0.5% 2mL plus 1mL of 0.9% saline (IV group ) with overall 3 ml volume intrathecally in each group. Duration of sensory block, postoperative analgesia, visual analog pain scale (VAS) score, time of rescue analgesia in the first 24 h, intra- and post-operative hemodynamics, and side effects if any were recorded. Results: The study groups, There was significantly higher postoperative analgesic duration (8.73 ± 2.64) hours compared to addition of Intravenous Dexamethasone (4.91 ± 1.02) hours or using hyperbaric bupivacaine alone (3.43 ± 0.71) hours with p-value <0.001. There was no effect on the time of onset of sensory block with no significant complications were detected. Conclusion: The addition of 2mg dexamethasone intrathecally as an adjuvant to spinal anesthesia during cesarean section prolong the duration of sensory block and postoperative analgesia. [ABSTRACT FROM AUTHOR]

Background: Spinal subarachnoid block (SAB) is the first choice anesthesia in lower abdominal and lower limb surgeries. It produces a varying degree of sensory analgesia, motor blockade, and sympathetic blockade depending on the dose, concentration, and volume of the local anesthetic given. This study was undertaken to assess the degree of sensory and motor block with 150 μg of oral versus intramuscular clonidine as an adjuvant to bupivacaine for spinal anesthesia. Aims and Objective: To compare the efficacy of oral versus intramuscular clonidine as an adjuvant to bupivacaine for the prolongation of sensory and motor block in patients undergoing lower abdominal and lower limb surgeries under SAB. Materials and Methods: After institutional ethical clearance, 90 patients were randomized into three groups scheduled for lower abdominal and lower limb surgeries under spinal anesthesia. • Group O: Bupivacaine 0.5% (heavy) 3.0 mL and oral clonidine 150 μg 1 h before spinal anesthesia. • Group I: Bupivacaine 0.5% (heavy) 3.0 mL and intramuscular clonidine 150 μg 1 h before spinal anesthesia. • Group C: Control group – 3 mL bupivacaine 0.5% (heavy) alone. Result: The onset of sensory block in Group O was 4.9 ± 0.52 min, whereas in Group I, it was 4.6 ± 0.42 min than Group C (5.1 ± 0.60). Onset of motor block was also significantly lower in Group O and Group I (3.9 ± 0.53 and 3.7 ± 0.42 min) than in Group C (4.4 ± 0.6 min) which was a control group. There was also a significant difference in the duration of the sensory block between Group O (206.4 ± 9.2 min), Group I (219 ± 8.6 min), and Group C (184.3 ± 9.1 min). The duration of motor block was significantly higher in Group O (183.6 ± 8.2 min) and Group I (197.8 ± 9.6 min) when compared to Group C (162.8 ± 8.9 min). The timing of rescue analgesia in Group O was 222.4 ± 11.7 min, whereas in Group I, it was 243.46 ± 10.9. Conclusion: On the basis of finding of our study, we conclude that the use of clonidine as a premedication at a dose of 150 μg significantly increased the duration of sensory block, motor block, and duration of analgesia and shortened the time of onset of sensory and motor blockade. [ABSTRACT FROM AUTHOR]

Introduction: Dexmedetomidine has been frequently used in regional anaesthesia to improve the quality of blocks. Addition of dexmedetomidine to local anaesthetics has been shown to hasten the onset of both sensory and motor blocks and also prolong the duration of analgesia. The objective of this prospective comparative study was to assess the change in characteristics of infraclavicular brachial plexus block after adding Inj. Dexmedetomidine to 2% Lignocaine with Adrenaline. Methods: Sixty-six patients, scheduled for upper limb surgeries under ultrasound guided infraclavicular brachial plexus block were randomly allocated to two groups. Group LS received Inj. Lignocaine 2% with Adrenaline, 7mg/kg diluted to 30 ml with saline and Group LD received Inj. Dexmedetomidine 0.75 mcg/kg in addition to Inj. Lignocaine 2% with Adrenaline, 7mg/kg again diluted to a total volume of 30 ml. The parameters studied were: onset of sensory and motor blocks and duration of analgesia. Results: Sixty patients completed the study. The demographic variables and motor block were similar between both groups. The mean time to onset of sensory block was significantly faster in Group LD compared to Group LS (9.80±4.85 min vs 12.30±3.97 min, p=0.033). The duration of analgesia was also found to be prolonged in Group LD compared to Group LS (286.73±55.38 min vs 226.53±41.19 min, p < 0.001). Conclusion: Addition of 0.75 mcg/kg of Dexmedetomidine to 2% Lignocaine with Adrenaline hastens the onset of sensory block and prolongs the duration of analgesia in ultrasound guided and peripheral nerve stimulator guided infraclavicular block.

Introduction: Lower abdominal and lower limb surgeries may be performed under local, regional (spinal or epidural), or general anesthesia, but neuraxial blockade is the preferred mode of anesthesia. A spinal block is still the first choice because of its rapid onset, superior blockade, low risk of infection from the catheter in situ, fewer failure rates, and cost-effectiveness. However, postoperative pain control is a major problem because spinal anesthesia using only local anesthetics is associated with a relatively short duration of action, and thus early analgesic intervention is needed in the postoperative period. Several adjuvants have been studied to prolong the effect of spinal anesthesia. Various adjuvants have been used with local anesthetics in spinal anesthesia to avoid intraoperative visceral and somatic pain and to provide prolonged postoperative analgesia. Dexmedetomidine, the new highly selective a2-agonist drug, is now being used as a neuraxial adjuvant. This study aimed to evaluate the onset and duration of sensory and motor block, hemodynamic effect, postoperative analgesia, and adverse effects of dexmedetomidine given intrathecally with hyperbaric 0.5% bupivacaine. Aim of the study: To compare the effect of plain bupivacaine vs bupivacaine with fentanyl vs bupivacaine with dexmedetomidine administered intrathecally for lower abdominal surgeries. Materials and method: This study was done in a prospective double-blinded randomized manner. It was conducted at our institute between March 2018 to August 2018 after approval from the ethical committee of the institution and written informed consent. 90 American society of Anesthesiology I patients undergoing elective lower abdominal surgeries under spinal anesthesia were recruited. The volume of the drug, size of the syringe, color of the drug of interest was similar in the three groups. The final volume of injected solutions was 3.0 ml into three groups. In the premedication room pulse rate, BP, RR, and spO2 were monitored. An IV line was secured with an 18G cannula. Preloading was done with RL 500 ml - 1000 ml) over 20-30 mts. Results: The time taken to achieve a sensory level of T10 from the time of SAB was tested by alcohol swab (loss of cold sensation). The mean time taken in Group B was 2.83±0.53min and in Group F was 2.93±0.58 min. And in group D was 2.67+0.48min. There was statistically no significant difference among the three groups (p < 0.153). The time taken to achieve a peak sensory level of T6 from the time of SAB was tested by alcohol swab. The mean time taken in Group B was 4.80 ± 0.76 min, in Group F was 5.03 ± 0.85 min, and group D was 4.77+0.68. There was no statistically significant difference among the three groups p < 0.345. The time taken to achieve Bromage 3 from the time of SAB was tested by a modified Bromage scale. The mean time taken in Group B was 6.63 ± 0.56 min, group F was 6.67+0.55 min and group D was 6.53+0.68 There was statistically no significant difference among the three groups p < 0.669. The mean time taken for the return of cold sensation to S1 level was 305.63±44.50 min in Group B, in Group F was 358.97 ±46.74 mins and in the group, D was 457.30+54.28. The mean duration of return of motor block to Bromage scale zero [0] was 231.33±40.77 min in Group F and Group D was 279.43±56.01 and in the group, B was 171.83+39.98 mins. There was a statistically significant difference among the three groups in the mean duration of motor block p < 0.0001. The quality of surgical anesthesia was excellent in all patients. There was no statistically significant difference among the three groups p < 1. Conclusion: Intrathecal Dexmedetomidine supplementation of the spinal block seems to be a good alternative to intrathecal fentanyl since it produces prolonged sensory block and motor block. This type of block may be more suitable for lower abdomen and lower extremities surgeries with a prolonged duration. [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: 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 post-operative analgesia, along with the bupivacaine. Intrathecal ketamine, which is a N-Methyl D-Aspartate (NMDA) blocker prolongs the duration of post-operative analgesia due to inhibition of dorsal horn. Aim: To assess the duration of post-operative 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 post-operative analgesia with better haemodynamic stability than bupivacaine alone.

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]

Objective: To examine the efficacy of dexmedetomidine with hyperbaric bupivacaine 0.5% in spinal anesthesia for patients undergoing Illiazorov surgery. Methodology: This cross-sectional/observational study was conducted at Orthopedics and Spine Centre, Ghurki Trust Teaching Hospital (GTTH) Lahore for two months from 20th August 2018 to 20th October 2018. In this study 52 patients of both genders undergoing lower limb surgeries were included. Patient’s ages ranged from 18 to 65 y. Detailed medical history and informed consent was taken from all of the patients. The patients were randomly divided into two groups using a computer generated random number table. Group-I included 26 patients and received inj. dexmedetomidine 10 μg in 0.5 ml of normal saline along with 12.5 mg of 0.5% hyperbaric bupivacaine (2.5 ml), while the Group-II had 26 patients and received only 0.5ml of normal saline with 12.5 mg of 0.5% hyperbaric bupivacaine(2.5ml). Results were noted in both groups as time to achieve T10 sensory blockade and time to first rescue analgesia after spinal anesthesia. Results: There were 19 (73.08%) male patients and 7 (26.92%) females in Group-I while in Group-II 21 (80.77%) patients were male and 5 (19.23%) were females. We observed the results were similar with respect to the time to reach T10 sensory blockade. But, we observed a significant difference in time to first rescue analgesia after spinal anesthesia. In Group-I, it was 270.35 min while in Group-II, it was 182.25 min. Conclusion: In this study, we concluded that there was a significant difference in two groups with respect to the time to first rescue analgesia after spinal anesthesia with and without using dexmedetomidine in addition to 0.5% bupivacaine in spinal anesthesia for Illiazorov surgery. [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]

Background: Ultrasound guidance has reduced the amount of local anesthetics to achieve a successful block. Previous studies of the relationship between the volume or concentration of local anesthetics and the effects of the block were based on relatively high doses of local anesthetics. We tested the hypothesis that providing low dose of ropivacaine at three combinations of volumes and concentrations for ultrasound-guided interscalene brachial plexus block would produce different effects in the aspect of onset time, pain control and the incidence of side effects. Methods: Ninety-nine patients undergoing elective arthroscopic shoulder surgery were randomized to receive an ultrasound guided combined with nerve stimulator mediated interscalene block with ropivacaine 0.75 % (6.7 ml, Group 0.75), 0.5 % (10 ml, Group 0.5) or 0.25 % (20 ml, Group 0.25). The primary end point was the onset time of the sensory blockade, assessed by using a pinprick in the C5-6 dermatome. The secondary end points included the onset time of the motor blockade, block success rate, postoperative pain rating score, rescue analgesics requirement, sleep quality, strength of the hand on the block side,and the incidence of hemi-diaphragmatic paresis which was evaluated by ultrasonography. Results: There was a statistically significant difference of the sensory block median onset times among Group 0.75 (5 min), Group 0.5 (10 min) and Group 0.25 (20 min). One patient in Group 0.5 and 20 patients in Group 0.25 did not achieve a complete motor block within 30 min, which were also significantly different. No significant difference was observed in postoperative analgesia, decrease of handgrip strength and the incidence of hemi-diaphragmatic paresis among the 3 groups. Conclusions: This study demonstrates that ropivacaine 50 mg as 0.25, 0.5 or 0.75 % solution for interscalene brachial plexus block before arthroscopic shoulder surgery produces comparable blockade with few side effects, while 0.75 % seems to be more preferable as it is associated with faster onset time. Trial registration: ChiCTR-TRC-13004058. Registered 4 December 2013. [ABSTRACT FROM AUTHOR]

Context: Spinal anesthesia is preferred choice of anesthesia in lower abdominal surgeries since long time. However problem with this is limited duration of action, so for long duration surgeries alternative are required. Dexmedetomidine is a highly selective alpha-2-adrenergic agonist has property to potentiate the action of local anesthetic used in spinal anesthesia. Fentanyl is an opioid and it has also the same property. Aims: To compare the efficacy, analgesic effects, and side-effects of dexmedetomidine and fentanyl as adjuvant to bupivacaine for lower abdominal surgery. Settings and Design: The type of this study was double-blind randomized trial. Subjects and Methods: A total of 80 patients were randomly allocated in two Group D and Group F . Group D were injected injection bupivacaine 0.5% heavy x 3.0 ml + 0.5 ml of preservative free normal saline containing 5 µg dexmedetomidine. Group F were received injection bupivacaine 0.5% heavy x 3.0 ml + 0.5 ml fentanyl equivalent to 25 µg. Statistical Analysis Used: The statistical analysis was performed using SPSS (Statistical Package for Social Sciences) version 15.0 statistical analysis software. Results: The results show that highest sensitivity level of T6 and T8 was achieved by higher proportion of subjects from Group D when compared to Group F and sensitivity level T7 was achieved by higher proportion of subjects of Group F when compared to Group D. Duration of analgesic properties was significantly higher in Group D when compared to Group F. Conclusion: The findings in the present study suggested that intrathecal adjuvant use of dexmedetomidine as compared to fentanyl provides a longer sensory and motor blockade and also prolongs the postoperative analgesic effect. [ABSTRACT FROM AUTHOR]