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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]

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: Bupivacaine and ropivacaine have identical PKA values, however ropivacaine is less fat soluble, implying that ropivacaine will block A-alpha fibers more slowly than bupivacaine. Isobaric solution has the extra benefit of not affecting the intrathecal dissemination of local anaesthetic during and after injection. The purpose of this study was to compare the anaesthetic efficacy of intrathecal isobaric ropivacaine 0.5% to isobaric bupivacaine 0.5% in lower abdominal procedures in terms of: 1. Onset and duration of sensory block, 2. Onset, quality, and duration of motor block, and 3. Hemodynamic alterations. Material and Methods: The present study was a Prospective randomized comparative Study. This Study was conducted January 2021 to December 2022 at department of Anesthesiology, Iqcty medical College nd hospital, Durgapur. Total 100 patients were included in this study. Results: Intrathecal isobaric 0.5% ropivacaine causes a delayed onset but identical length of sensory block and a statistically significant shorter duration of motor block. Both groups have identical haemodynamics and block height (highest sensory level). Conclusion: Because of the shorter length of motor blockade and comparable duration of sensory blockade, haemodynamics, and blockade height, 0.5% isobaric ropivacaine is a superior choice for ambulatory anaesthesia. [ABSTRACT FROM AUTHOR]

Introduction: Brachial plexus block is a regional anaesthesia technique used for upper extremity surgery that is a safe alternative to GA for upper limb procedures. Ropivacaine is a new long-acting local anaesthetic which produces less cardiac and central nervous system toxicity. Fentanyl and Tramadol, synthetic opioids are added to local anaesthetics to improve peripheral block quality in peripheral nerve blocks and to extend postoperative analgesia. Tramadol is a weak-opioid receptor agonist and has central analgesic effects and also has peripheral local anaesthetic properties that led to its use as an adjunct in peripheral nerve blocks. Tramadol is a relatively weak opioid with less respiratory depressant effects. With this background, we conducted a comparative study to study the effect of tramadol as an adjuvant to ropivacaine and ropivacaine plain in terms of quality, onset and duration of anaesthesia in supraclavicular brachial plexus block. Methods: The present clinical randomized comparative prospective controlled study was conducted amongst 70 patients undergoing surgery under supraclavicular brachial plexus block during the period of November 2020 - June 2022 amongst the patients between the ages of 18-60 years of age of ASA I and II who were scheduled for elective upper limb orthopaedics surgery. The patients were divided into groups, Group 1 (n=35) receiving 28 ml 0.5% ropivacaine + 2 ml normal saline and Group 2 (n=35) receiving 28 ml 0.5% ropivacaine + 2 ml tramadol (50mg/ml). Results: In the present study among the Ropivacaine group, the majority were of age 51-60 years 23(65.7%) and among the Ropivacaine + Tramadol group, of age 51-60 years 18(51.4%). The onset of sensory and motor block was earlier in Ropivacaine + Tramadol group. The duration of sensory and motor block was more in Ropivacaine + Tramadol group. Among Ropivacaine + Tramadol group According to VAS Score, at recovery, the Mean was 3.25 with an SD of 0.44. Among Ropivacaine group Nausea present among 10(28.6%), Vomiting among 6(17.1%), Bradycardia among 9(25.7. Among Ropivacaine + Tramadol group Nausea present among 6(17.1%), Vomiting among 7(20%), Bradycardia among 5(14.3%). Among the Ropivacaine + Tramadol group, according to the satisfaction of analgesia, was Present among 33(94.3%) and absent among 2(5.7%). Conclusion: We concluded that there was no significant difference between the two groups in terms of hemodynamic changes. The onset and duration of sensory and motor block were better in Ropivacaine + Tramadol group. Post-operative pain management with Ropivacaine + Tramadol was more acceptable by patients. Therefore, its use should be promoted for routine addition to local anaesthetics in peripheral nerve blocks. [ABSTRACT FROM AUTHOR]

Aim and objective: To Examine the effect of addition of dexamethasone and clonidine to local anaesthetic drug in (0.5% Bupivacaine+ 2% lignocaine with adrenaline) in PNS guided Supraclavicular brachial plexus block. Methodology: 90 patients presenting for upper limb surgery were divided into three groups. Group D receive Dexamethasone 8 mg as an adjuvant to Bupivacaine+ lignocaine whereas Group C receive Clonidine 75 mcg as an adjuvant to bupivacaine+ lignocaine and Group S is control group receiving saline as an adjuvant to bupivacaine+ lignocaine with adrenaline in Supraclavicular Brachial Plexus block. Results: The mean duration of motor block in group S was 5.74±0.384 hr, whereas in grp C it was 8.86±0.846 hr, for group D it was 9.32±0.964 hr on comparing the three groups there is significant difference between three group. The mean duration of sensory block in group S was 6.86±0.38 hr, whereas in grp C it was 9.86±0.98 hr, and group D it was 10.68±0.88 hr on comparing the three groups there is significant difference between these group. Onset of sensory and motor block was also better in dexamethasone group. Conclusions: We conclude from our study that dexamethasone added to bupivacaine plus lignocaine are of better efficacy in prolonging analgesia than clonidine and control with better hemodynamic fluctuation having no 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]

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]

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]

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]

Objective: This study aims to compare stimulator-guided peripheral nerve block with and without ultrasonography techniques to investigate the block procedure time, sensory and motor block onset time, pain related to the block procedure-related pain, and anesthesia-related complications. Methods: Patients were randomized into two groups: The nerve stimulator (NS)-guided technique group (n=30) and the NS with ultrasound (NU)-guided technique group (n=30). One-quarter of the solution prepared with prilocaine 2% and lidocaine 2% with the height/5 formula was injected around each nerve after receiving a motor response between 0.3-0.5 mA. The block procedure time, sensory and motor block onset time, the number of skin punctures, procedure-related preoperative complications, procedure-related postoperative complications, and visual analog scale (VAS) (0-10) scores were recorded. The heart rate, systolic arterial pressure, diastolic arterial pressure, mean arterial pressure, and peripheral oxygen saturation values were noted at 0, 5, 10, 15, 30, 45, 60, 120, and 180 minutes. Results: The block procedure time was similar between them (p>0.05). The number of skin punctures (p=0.001) and VAS (p<0.045) were significantly higher in the NS group. The sensory and motor block onset times were significantly similar (p>0.05) except for the motor block of musculocutaneous nerve onset time (p<0.05). Although the success rate was higher in the NU group, there was no statistically significant difference between the groups (p>0.05). The number of complications was significantly higher in the NS group (p<0.05). Conclusion: Using ultrasonography with the NS in the axillary approach to brachial block improves the success rate with a lower incidence rate of complications. [ABSTRACT FROM AUTHOR]

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]

Background and Aims: Antioxidant- and preservative-free form of 2-chloroprocaine (1%) has been re-emerged as a short-acting local anesthetic for use in spinal anesthesia. This study aimed to compare the effects of intrathecal 2-chloroprocaine (1%) alone or with fentanyl or clonidine used as an adjuvant for infraumbilical surgeries. Materials and Methods: Ninety patients of either sex aged between 18 and 60 years with American Society of Anesthesiologists Grade I or II scheduled for infraumbilical surgeries were randomly allocated into three groups (n = 30). Group C received intrathecal 1% 2-chloroprocaine 5 ml (50 mg) + 0.5 ml normal saline, Group CF received intrathecal 1% 2-chloroprocaine 5 ml (50 mg) + 0.5 ml fentanyl (25 µg), and Group CC received intrathecal 1% 2-chloroprocaine 5 ml (50 mg) + 0.5 ml clonidine (15 µg) diluted in normal saline. The onset and duration of sensory and motor blocks, time for demand of rescue analgesia, hemodynamics, and side effects were observed. Results: The onset of sensory and motor blocks was significantly earlier, and the duration of sensory and blocks and time to demand of rescue analgesia were significantly prolonged in both Group CF and Group CC as compared to Group C. Among Groups CF and CC, the duration of sensory and blocks and time to demand of rescue analgesia were significantly prolonged in Group CC. Conclusion: Intrathecal clonidine (15 µg) proved to be a better alternative to fentanyl (25 µg) used as an adjuvant to 1% 2-chloroprocaine for infraumbilical surgeries. [ABSTRACT FROM AUTHOR]

Background: Pain is abnoxius stimulus after surgery. This study was undertaken to evaluate the post-operative analgesic benefits in patients administered with epidural butorphanol and nalbuphine as adjuvants with local anesthetic post operatively for abdominal hysterectomy under epidural anaesthesia and to compare their post-operative efficacy. Material and methods: An RCT was conducted among 80 patients who were divided into two equal groups by computer generated random numbers. One group received Butorphanol and other received Nalbuphine. The sensory block, motor block, duration of analgesia, quality of analgesia and side effects were compared between the two groups. Results: There was no difference in the pulse rates of patients belonging to both the groups. Not much variation was recorded in systolic and diastolic blood pressures in both the groups. The mean onset of sensory block in Butorphanol group was 5.9 min and 4.6 min in Nalbuphine group. The mean pain score was 1.0 after three hours of injection in the butorphanol group and Nalbuphine group. The duration of analgesia was 7.85 hours in the Butorphanol and 7.88 hours in the Nalbuphine group. Nausea/vomiting were the main complication among the Butorphanol group and also found in Nalbuphine group. In butorphanol group, the quality of analgesia was good in 93.3% and in Nalbuphine group in 90.0% of the cases. Conclusion: Both butorphanol and Nalbuphine had comparable efficacy and side effects as adjuvants in epidural anesthesia. [ABSTRACT FROM AUTHOR]

Dexmedetomidine (DEX) can prolong duration of anesthesia and shorten onset of sensory and motor block relative to clonidine. This study attempted to compare the efficacy of intravenous DEX and clonidine for hemodynamic changes and block after spinal anesthesia with ropivacaine in lower limb orthopedic surgery. In a double-blind randomized clinical trial, 120 patients undergoing spinal anesthesia in lower limb orthopedic surgery were recruited and divided into three groups using balanced block randomization: DEX group (n = 40; intravenous DEX 0.2 µg/kg), clonidine group (n = 40; intravenous clonidine 0.4 µg/kg), and placebo group (n = 40; intravenous normal saline 10 mL) in which pain scores were assessed using visual analogue scales (at recovery, and 2, 4, 6, and 12 hours after surgery) and time to achieve and onset of sensory and motor block. Statistically significant differences were found in mean arterial pressure among the groups at all times except baseline (P = 0.001), with a less mean arterial pressure and a prolonged duration of sensory and motor block (P = 0.001) in the DEX group where pain relieved in patients immediately after surgery and at above mentioned time points (P = 0.001). Simultaneous administration of intravenous DEX with ropivacaine for spinal anesthesia prolongs the duration of sensory and motor block and relieves postoperative pain, and however, can decrease blood pressure. Although intravenous DEX as an adjuvant can be helpful during spinal anesthesia with ropivacaine, it should be taken with caution owing to a lowering of mean arterial pressure in patients especially in the older adults. This study was approved by Ethical Committee of Arak University of Medical Sciences (No. IR.Arakmu.Rec.1395.450) in March, 2017, and the trial was registered and approved by the Iranian Registry of Clinical Trials (IRCT No. IRCT2017092020258N60) in 2017. [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]

Background: Spinal anesthesia is a reliable and safe technique for infra-umbilical surgeries. Preservative-free 2-chloroprocaine has re-emerged for use in spinal anesthesia. We compared onset and duration of sensory block with intrathecal use of 1% 2-chloroprocaine (30 mg) or 0.5% Hyperbaric Bupivacaine (15 mg) as primary objective. Secondary objectives being onset and duration of motor block, duration of analgesia, time to return of voiding function, hemodynamic parameters and side effects. Methodology: 90 patients of age group 18-60 years, either sex, belonging to ASA physical status I/II undergoing infra-umbilical surgeries were randomly divided into two groups, 1% 2-chloroprocaine Group A (n=45) and 0.5% hyperbaric bupivacaine Group B (n=45). Each group received intrathecally either 30 mg of 2-chloroprocaine or 15 mg of hyperbaric bupivacaine 15 mg. For statistical analysis unpaired-t-test and chi-square test were used. Results: Earlier onset and shorter duration of sensory block were observed in Group A as compared to Group B respectively (p < 0.001). Similarly, onset was earlier and duration of motor block, duration of analgesia and time to return of voiding function were shorter in Group A as compared to Group B respectively (p < 0.001). Hemodynamic parameters (HR, MAP) were comparable in both groups. Conclusion: Intrathecal 1% 2-chloroprocaine 30 mg provides spinal anesthesia of adequate duration for infra-umbilical surgeries with the advantage of earlier onset and faster regression of spinal block resulting in earlier voiding with stable hemodynamics as compared to 0.5% hyperbaric bupivacaine 15 mg. [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: Dexmedetomidine has been proposed as a perineural local anaesthetic (LA) adjunct to prolong peripheral nerve block duration; however, results from our previous meta-analysis in the setting of brachial plexus block (BPB) did not support its use. Many additional randomized trials have since been published. We thus conducted an updated meta-analysis.Methods: Randomized trials investigating the addition of dexmedetomidine to LA compared with LA alone (Control) in BPB for upper extremity surgery were sought. Sensory and motor block duration, onset times, duration of analgesia, analgesic consumption, pain severity, patient satisfaction, and dexmedetomidine-related side-effects were analysed using random-effects modeling. We used ratio-of-means (lower confidence interval [point estimate]) for continuous outcomes.Results: We identified 32 trials (2007 patients), and found that dexmedetomidine prolonged sensory block (at least 57%, P < 0.0001), motor block (at least 58%, P < 0.0001), and analgesia (at least 63%, P < 0.0001) duration. Dexmedetomidine expedited onset for both sensory (at least 40%, P < 0.0001) and motor (at least 39%, P < 0.0001) blocks. Dexmedetomidine also reduced postoperative oral morphine consumption by 10.2mg [-15.3, -5.2] (P < 0.0001), improved pain control, and enhanced satisfaction. In contrast, dexmedetomidine increased odds of bradycardia (3.3 [0.8, 13.5](P = 0.0002)), and hypotension (5.4 [2.7, 11.0] (P < 0.0001)). A 50-60µg dexmedetomidine dose maximized sensory block duration while minimizing haemodynamic side-effects. No patients experienced any neurologic sequelae. Evidence quality for sensory block was high according to the GRADE system.Conclusions: New evidence now indicates that perineural dexmedetomidine improves BPB onset, quality, and analgesia. However, these benefits should be weighed against increased risks of motor block prolongation and transient bradycardia and hypotension. [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]

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]

Background: The interscalene brachial plexus block is widely used for pain control and anesthetic purposes during shoulder arthroscopic surgeries and surgeries of the upper extremities. However, it is known that interscalene brachial plexus block is not appropriate for upper limb surgeries because it does not affect the lower trunk (C8-T1, ulnar nerve) of the brachial plexus. Methods: A low approach, ultrasound-guided interscalene brachial plexus block (LISB) was performed on twenty-eight patients undergoing surgery of the upper extremities. The patients were assessed five minutes and fifteen minutes after the block for the degree of block in each nerve and muscle as well as for any complications. Results: At five minutes and fifteen minutes after the performance of the block, the degree of the block in the ulnar nerve was found to be 2.8 ± 2.6 and 1.1 ± 1.8, respectively, based on a ten-point scale. Motor block occurred in the median nerve after fifteen minutes in 26 of the 28 patients (92.8%), and in all of the other three nerves in all 28 patients. None of the patients received additional analgesics, and none experienced complications. Conclusions: The present study confirmed the achievement of an appropriate sensory and motor block in the upper extremities, including the ulnar nerve, fifteen minutes after LISB, with no complications. [ABSTRACT FROM AUTHOR]

The axillary approach of brachial plexus anesthesia is the most commonly used technique for forearm and hand surgery. Dynamometer is known as objective test for the clinical assessment of motor block of the nerves in brachial plexus block. However, the use of this device may not always be practical in operating room. The train-of-four (TOF) test is a non-invasive peripheral nerve stimulator that shows the level of motor block of muscle relaxants. The aim of the study is to investigate the use of TOF testing as a peripheral nerve stimulator for objective clinical evaluation of motor block at axillary brachial plexus block. 44 patients were randomized according to the development of partial or complete motor in the axillary brachial plexus block. The nerves were selectively localized by nerve stimulation and ultrasound guidance. After obtaining an appropriate peripheral motor response, predetermined volumes of bupivacaine were selectively injected to the 4 nerves. Sensory, motor block levels and TOF values were measured at 10th, 20th, 30th minutes immediately after the axillary brachial plexus block. TOF values were gradually decreased and significant difference was observed between the development of a complete and partial motor block at 30th minute. TOF values were also significantly less in patients of complete sensory block than the patients of partial sensory block at 30th minute. The use of TOF monitoring may be beneficial to assess the objective clinical effect of motor block in the patients with axillary brachial plexus nerve block. [ABSTRACT FROM AUTHOR]

Objective: To assess whether sequential (one after the other with a delay of 120 s) or combined (freshly prepared mixture) administration of 2% lidocaine and 0.5% bupivacaine in supraclavicular brachial plexus block (SCBPB) provides faster onset and prolonged duration of block.Design: Randomised controlled double blinded study.Setting: Single centre study in an operating theatre of a tertiary care facility between November 2018 and May 2020.Patients: Ninety-seven patients of either sex, aged between 18 and 65 years, belonging to ASA I to III and undergoing surgery suitable to be performed under SCBPB were enrolled.Intervention: Ultrasound guided SCBPB was performed with 20 mL of freshly prepared mixture of 2% lidocaine and 0.5% bupivacaine (10 mL each) in group C (combined) and 10 mL 2% lidocaine followed 120 s later by 10 mL 0.5% bupivacaine in group S (sequential).Main Outcome Measures: Time to onset of complete sensory block was the primary outcome while time to onset of first sensory block and complete motor block, duration of sensory and motor block, duration of analgesia, use of intraoperative supplement, rescue analgesic consumption, and pain scores at rest and with movement were secondary outcomes.Main Results: There was no significant difference between group C and group S in time to onset of complete sensory block [median (IQR) 16 (11, 20.5) and 15.5 (13, 21.75) minutes respectively] (p-value 0.58). The time to onset of first sensory block and motor block, duration of sensory and motor block, duration of analgesia, use of intraoperative supplement, postoperative pain scores and rescue analgesic requirement were also similar (p-value >0.05).Conclusion: There was no advantage of sequential administration of 2% lidocaine and 0.5% bupivacaine over the administration of combination of both LAs in terms of onset and duration of block. [ABSTRACT FROM AUTHOR]