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Introduction: spinal anaesthesia has emerged as a most popular technique for abdominal and lower abdominal surgeries for its safety, simplicity and effectivity. Adding adjuvants drugs to intrathecal local anaesthetics improves quality and duration of spinal blockade, and prolongs postoperative analgesia. Intrathecal dexmedetomidine with low-dose bupivacaine provides faster onset, prolonged sensory and motor block and reduced rescue analgesic requirement in patient undergoing TURP. Aims and objectives: To assess the Onset of sensory analgesia, onset of motor block, fixation time of sensory block, highest level of sensory block, quality of analgesia. Material and methods: This Prospective - Randomized study was conducted in the Anaesthesia Anaesthesia Department in Government Medical College, Nagpur from December 2018 to November 2020. 60 adult female patients between the age of 18 and 60 years participated in the study. The samples were equally divided into 2 groups, Group D-Case group-30 patients and Group B-Control group-30 patients. Intravenous cannula of 18/20 G was secured and patient was preloaded with 10ml/kg of Ringer lactate solution over 10-30 minutes. Baseline vital signs such blood pressure, pulse rate were recorded. Result: Maximum number of patients in group D and group B i. e 100% and 60% respectively had an excellent quality of analgesia during the procedure. Quality of analgesia was reported as satisfactory in 30% of patients and poor in 10% patients in group B. Quality of analgesia was found to be comparable in the two groups (p= 0.001). Thus, addition of dexmedetomidine only marginally improved quality of surgical analgesia in our study. Conclusion: Intrathecal inj. Dexmedetomidine 5mcg acts synergistically to potentiate intrathecal local anaesthetic bupivacaine with the result that there is relatively faster onset of sensory block and prolongation of both sensory and motor block. [ABSTRACT FROM AUTHOR]

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

OBJECTIVE: This study aimed to investigate whether the administration of intrathecal dexmedetomidine as a bupivacaine adjuvant for caesarean section can prolong the duration of analgesia compared with bupivacaine alone. Secondary outcomes included postoperative pain, the time interval to the first analgesic request, the level of sedation, the incidence of adverse effects, and the fetal outcomes. MATERIALS AND METHODS: A systematic review and meta-analysis were conducted. The study compared the intrathecal administration of bupivacaine plus dexmedetomidine (group BD) to the intrathecal administration of bupivacaine alone (group B) for cesarean sections. RESULTS: Fourteen publications were included. Among patients who underwent spinal anesthesia for a cesarean section, 514 patients received intrathecal bupivacaine alone, and 533 patients received intrathecal bupivacaine plus dexmedetomidine. The onset of sensory and motor block was essentially the same in both groups; the time for sensory and motor block regression was significantly longer in the BD group. Postoperative Visual Analogue Scale (VAS) values were similar in group BD when compared to group B. Postoperative VAS scores remained consistently low in Group BD compared to Group B, starting from 1 hour after surgery. The level of sedation measured at the end of the cesarean section in both groups was almost similar. No difference in terms of safety, adverse events, and neonatal outcomes was found between the two groups. CONCLUSIONS: Use of intrathecal dexmedetomidine for spinal anesthesia in cesarean section significantly prolongs sensory and motor block compared to using bupivacaine alone as an adjuvant. It also improves analgesia after 1 hour with no difference in the incidence of maternal and neonatal adverse effects compared to bupivacaine alone. The optimal dose of dexmedetomidine to use remains to be ingested. [ABSTRACT FROM AUTHOR]

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

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]

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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

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

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

Introduction: Spinal anaesthesia is the choice technique for Lower Segment Caesarean Section (LSCS). When using subarachnoid block (spinal analgesia), opioids are employed as the main adjuvants along with local anaesthetics to achieve intra/postoperative analgesia. These opioids have desirable properties such as reducing the dose of local anaesthetics, minimising side-effects, providing analgesia, and prolonging the duration of anaesthesia. Aim: To evaluate and compare the efficacy between intrathecal Buprenorphine and Fentanyl as adjuvants to hyperbaric bupivacaine (0.5%) in women undergoing LSCS under spinal anaesthesia. Materials and Methods: A randomised double-blinded clinical trial was conducted at Bharati Vidyapeeth Hospital and Research Centre in Pune, Maharashtra, India between July 2021 and February 2022. A total of 80 parturients with American Society of Anaesthesilogists (ASA) grade II, aged 18 and older, scheduled for elective LSCS, were randomly divided into two groups of 40 each. Group B received 1.8 mL of 0.5% Bupivacaine with 60 μg Buprenorphine, while Group F received 1.8 mL of 0.5% Bupivacaine with 25 μg Fentanyl. The onset/duration of motor block and sensory block, intraoperative haemodynamics, sideeffects, 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

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]

Abstract Background The purpose of this study was to investigate the effect of intravenous (IV) dexamethasone on the duration of hyperbaric bupivacaine spinal anesthesia. Methods Two hundred patients between the ages of 18 and 60, of both sexes with ASA I- II classification scheduled for lower abdominal surgery under spinal anesthesia using hyperbaric bupivacaine 0.5% were randomly divided into two groups: the dexamethasone group (Dexa group) and the control group, with 100 patients in each group. Before the administration of spinal anesthesia, the Dexa group received an intravenous infusion of 8 mg dexamethasone in 500 mL normal saline, while the control group received 500 mL normal saline only. The primary outcome of this study was to assess the effect of IV dexamethasone on the regression of hyperbaric bupivacaine spinal anesthesia. Secondary outcome measures included the total duration of sensory and motor blocks, VAS score, time of first analgesic request, total analgesic consumption within the first 24 h, and the occurrence of any side effects. Results The Dexa group had significantly delayed onset of 2 dermatomes regression (P

OBJECTIVE: In this prospective randomized controlled study, we aimed to evaluate the effects of the administration of equal doses of bupivacaine and morphine (BM) at high volume and low concentration (HV-LC) or low volume and high concentration (LV-HC) on the number of drugs consumed, pain scores and side effects. PATIENTS AND METHODS: We randomized 64 patients who underwent thoracotomy into two groups. Group 1 received a solution prepared with 0.12% bupivacaine and 0.05 mg/cc morphine, administered with a basal infusion rate of 4 cc/h, a 2-cc bolus dose, and a 30-minute lockout time. Group 2 received a solution prepared with 0.48% bupivacaine and 0.2 mg/cc morphine, administered with a basal infusion rate of 1 cc/h, a 0.5-cc bolus dose, and a 30-minute lockout time. We compared patient-controlled epidural analgesia (PCEA) usage doses, pain scores, sensory and motor block, hemodynamic effects, side effects, and patient satisfaction in the postoperative periods. RESULTS: An increase in drug consumption with PCEA was found in the first 24 hours postoperatively in Group 2 (p<0.05). Resting visual analog scale (VAS) scores were statistically significantly higher at hours 2, 28, 32, 36, 44 and coughing VAS scores were also higher at hours 2 and 20 in Group 2. Heart rates in Group 2 were lower than in Group 1 at hours 16, 24, 44 and 48 (p<0.05). The cephalic spread of the sensory block in Group 1 was more extensive (p<0.05). The groups demonstrated no significant differences regarding side effects and patient satisfaction (p>0.05). CONCLUSIONS: The HV-LC approach resulted in better analgesia, less drug consumption, and greater cephalic spread of sensory block than the LV-HC approach. Both applications were effective and safe in terms of analgesia and side effects. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to investigate the effect of intravenous (IV) dexamethasone on the duration of hyperbaric bupivacaine spinal anesthesia. Methods: Two hundred patients between the ages of 18 and 60, of both sexes with ASA I- II classification scheduled for lower abdominal surgery under spinal anesthesia using hyperbaric bupivacaine 0.5% were randomly divided into two groups: the dexamethasone group (Dexa group) and the control group, with 100 patients in each group. Before the administration of spinal anesthesia, the Dexa group received an intravenous infusion of 8 mg dexamethasone in 500 mL normal saline, while the control group received 500 mL normal saline only. The primary outcome of this study was to assess the effect of IV dexamethasone on the regression of hyperbaric bupivacaine spinal anesthesia. Secondary outcome measures included the total duration of sensory and motor blocks, VAS score, time of first analgesic request, total analgesic consumption within the first 24 h, and the occurrence of any side effects. Results: The Dexa group had significantly delayed onset of 2 dermatomes regression (P < 0.001) compared to the control group. Additionally, the Dexa group had significantly longer duration of both sensory block (P = 0.01) and motor block (P < 0.001). The Dexa group had significantly longer duration until the first postoperative analgesic request (P < 0.001) and a lower incidence of side effects compared to the control group. Conclusion: Although the intravenous administration of dexamethasone had a limited effect on the duration of hyperbaric bupivacaine spinal anesthesia, it improved postoperative VAS scores compared to the control group and decreased overall postoperative analgesic consumption. Therefore, it can be considered a valuable addition to postoperative multimodal analgesia strategies, aiming to minimize total analgesic consumption. Clinical trial registration: ID: NCT04778189 (2/3/2021). [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

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: Cataract surgery is performed under peribulbar or retrobulbar block. Majority of the patients posted for cataract have some form of medical diseases like diabetes, hypertension, angina, ischaemic heart disease etc. Lidocaine and bupivacaine are the most commonly used local anesthetic for the block procedure. Here we compare the efficacy of peribulbar block in cataract surgery using the combination of 1:1 mixture of 2% lidocaine with 0.5% bupivacaine and 1:1 mixture of 2% lidocaine with 0.75% ropivacaine. Materials and Methods: It is a prospective, randomized, double blinded study including 60 patients were devided into two groups of 30 each, Group-R received 8 ml of 1:1 mixture of 4 ml of 2% lidocaine, 4 ml of 0.75% ropivacaine and 15 IU/ml of hyaluronidase and group-B received 8 ml of 1:1 mixture of 4 ml of 2% lidocaine, 4 ml of 0. 5% bubivacaineand 15 IU/ml of hyaluronidase. Peribulbar block was performed as per Bloomberg's modification of the Davis and Mandel technique where 5 ml of local anesthetic was injected in the infero temporal region and 3 ml of drug was injected in the superi nasal area. Patients were assessed for sensory block, eyelid and occular movements at an interval of 2 minutes. Systolic, diastolic and mean arterial pressures, heart rate, oxygen saturation, ECG were monitored non invasively at 1,3,5,8,10,15 and then every 10 minutes till the end of the surgery. Observation and Discussion: Mean time for the onset of sensory blockade was 2.70 ± 6.5 minutes in Group B and 2.63 ± 0.57 minutes in group R with P-value 0.671, showing no significant difference in the onset of sensory blockade. Onset of motor blockade was 6.53 ± 1.81 minutes in group B, and 7.57 ± 1.46 minutes in the group R, the P-value being 0.018 was statistically significant. Regarding the duration of analgesia, our study showed mean time for analgesia lasted for 295 ± 54.63 minutes in group B and 414.67 ± 99.47 in group R with P value 0.001 showing statistically significant prolongation of duration of analgesia with group R. We observed a significant increase of mean IOP in bupivacaine group from 13.333 ± 1.582 mm Hg to 21.966 ± 2.697 mm Hg, whereas in ropivacaine group it increased from 12.766 ± 1.222 mm Hg to 13.0 ± 1.341 mm Hg after peribulbar anaesthesia. [ABSTRACT FROM AUTHOR]

Objectives: Increase in Intra-Abdominal Pressure (IAP) is commonly accepted as a cause for intrathecal dose sparing and consequently higher level of sensory block during pregnancy. There is however very little actual data evaluating the relationship. Thus, we aimed to evaluate association between IAP and maximum level of sensory block following intrathecal injection of hyperbaric bupivacaine as well as plain levobupivacaine for cesarean section. Methods: Preliminary randomized controlled blinded trial included females aged 18-40 years, scheduled for elective cesarean section under single-shot subarachnoid block. After randomization, they received either intrathecal hyperbaric bupivacaine (group H) or plain (isobaric) levobupivacaine (group P) in a dose of 12.5 mg (n = 40 each). IAP was measured before and after the spinal block, using the recommended intravesical technique. The maximum level of sensory block and the IAPs were measured in each patient. Results: There was no significant correlation of IAPprespinal with maximum level of sensory block for group H (P = 0.334; rs = -0.157) or group P (P = 0.637; rs = -0.078). Similarly, there was no significant correlation of the IAPpostspinal: group H (P = 0.370; rs = -0.145); and group P (P = 0.714; rs = -0.061). Both group H and group P had similar IAPprespinal (15.9 [14.3-18.2] and 15.3 [14.3-17.4] mmHg, respectively) (P = 0.474); as well as IAPpostspinal (15.2 [13.8-17.2] and 14.6 [13.4-16.0] mmH, g respectively) (P = 0.239). Among ancillary observations, duration of sensory block was significantly longer for group P versus group H (133.6 ± 24.2 and 103 ± 23.4 mins; P < 0.000). However, the maximum levels of sensory and motor block, respective times required to achieve them, as well as incidences of intraoperative hypotension and bradycardia were statistically similar between group H and group P (P > 0.05). Conclusions: The IAP was raised to the level of conventionally defined intra-abdominal hypertension (>12 mmHg) in patients scheduled for elective cesarean section. However, despite being increased, the IAPprespinal or IAPpostspinal did not show any significant association with the maximum level of sensory block (P > 0.05).

Background and Objective: The injection site in spinal anesthesia is one of the factors that can affect the height of the sensory block. This clinical trial study aimed to compare the effect of spinal anesthesia at L3-L4 and L4-L5 on the level of sensory-motor block and hemodynamic status in cesarean section. Materials and Methods: Seventy patients undergoing elective cesarean section and receiving spinal anesthesia (10 mg of 0.5% bupivacaine plus 2.5 μg of sufentanil) were randomly divided into two groups of 35 with spinal anesthesia at L3-L4 (group 1) or L4-L5 (group 2). The two groups were compared concerning demographic data, hemodynamic status, level of sensory block, degree of motor block, time to return the sensory level to T10, complications of spinal anesthesia, and neonate Apgar score. Results: There was no significant difference between the two groups in the mean age (P=0.329). In the first group, 22.9%, and in the second group, 40% of the patients had the level of anesthesia at the eighth thoracic vertebra (T8). None of the patients had zero or one score in both groups. Hypotension (82.9% vs. 8.6%), bradycardia (34.3% vs. 8.6%), and intraoperative nausea and vomiting (65.7% vs. 11.4%) were higher in the first group than in the second group (P

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]

Background and objectivesThis randomized, controlled, double-blind trial compared the effectiveness of levobupivacaine delivery of a programmed intermittent paravertebral bolus with a continuous paravertebral infusion.MethodsThirty-two consecutively enrolled patients who underwent unilateral video-assisted thoracic surgery were randomized to receive either a programmed intermittent paravertebral bolus of 10 mL of 0.2% levobupivacaine every 2 hours (Bolus group, n=16) or a continuous paravertebral infusion of 0.2% levobupivacaine at 5 mL/hour (Infusion group, n=16) after the operation. Postoperatively, after injection of 20 mL of 0.25% levobupivacaine through the paravertebral catheter, a mechanical infusion pump was set depending on the assigned group. The primary efficacy outcome was the number of anesthetized dermatomes 24 hours after the initial bolus of levobupivacaine. The secondary efficacy outcomes included the number of anesthetized dermatomes at other time points, pain at rest and coughing, additional analgesic use and patient acceptance of the analgesic technique. Arterial levobupivacaine concentration was measured to ensure safety. P

Rong Shi,1,&ast; Mingshuai Wang,2,&ast; Xiaoyong Yang,2 Peiqi Shao,1 Jinghan Liang,1 Yun Wang1 1Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China; 2Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yun Wang, Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, No. 8, South Gongti Road, Beijing, 100020, People’s Republic of China, Tel +86-10-85231463, Fax +86-10-65077808, Email wangyun129@ccmu.edu.cnPurpose: 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.Keywords: diaphragmatic apposition zone, laparoscopy, nephrectomy, sensory block, postoperative analgesia

Introduction: Brachial plexus blocks are routinely performed to provide anaesthesia and analgesia for upper limb orthopaedic surgeries. Various adjuvants are being added to local anaesthetic solution to prolong the duration of sensory and motor blockade to ensure successful completion of long duration surgeries with adequate postoperative analgesia. Clonidine is used in varying dosages as adjuvant for peripheral nerve block. Aim: To study different dosages of clonidine when used as an adjuvant in infraclavicular approach to brachial plexus block. Materials and Methods: The randomised double-blind clinical study enrolled 60 American Society of Anaesthesiologists (ASA) I and II patients, between ages of 18-60 years, undergoing elective forearm orthopaedic surgery, lasting more than one hour. Based on the dose of clonidine added, the patients were distributed to group I (75 μg); group II (100 μg) and group III (150 μg). They were compared with regard to onset and duration of sensory and motor blockade, haemodynamic parameters, quality of sedation and side-effects. The results were analysed using Statistical Package for the Social Sciences (SPSS) version 21.0. Results: Demographic profile was comparable between the study groups. The onset of sensory and motor duration was faster in group III (5.8±1.65 minutes; 10.08±0.98 minutes). Also, the duration of sensory and motor blockade was highest in group III (11.02±2.33 hours; 10.44±1.45 hours). Patients in group III had significantly higher level of sedation in comparison to other groups. Conclusion: Clonidine in a dose of 150 μg provides significantly longer duration of sensory and motor blockade without any adverse haemodynamic outcomes.

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]

Objectives: Increase in Intra-Abdominal Pressure (IAP) is commonly accepted as a cause for intrathecal dose sparing and consequently higher level of sensory block during pregnancy. There is however very little actual data evaluating the relationship. Thus, we aimed to evaluate association between IAP and maximum level of sensory block following intrathecal injection of hyperbaric bupivacaine as well as plain levobupivacaine for cesarean section. Methods: Preliminary randomized controlled blinded trial included females aged 18-40 years, scheduled for elective cesarean section under single-shot subarachnoid block. After randomization, they received either intrathecal hyperbaric bupivacaine (group H) or plain (isobaric) levobupivacaine (group P) in a dose of 12.5 mg (n = 40 each). IAP was measured before and after the spinal block, using the recommended intravesical technique. The maximum level of sensory block and the IAPs were measured in each patient. Results: There was no significant correlation of IAPprespinal with maximum level of sensory block for group H (P = 0.334; rs = -0.157) or group P (P = 0.637; rs = -0.078). Similarly, there was no significant correlation of the IAPpostspinal: group H (P = 0.370; rs = -0.145); and group P (P = 0.714; rs = -0.061). Both group H and group P had similar IAPprespinal (15.9 [14.3-18.2] and 15.3 [14.3-17.4] mmHg, respectively) (P = 0.474); as well as IAPpostspinal (15.2 [13.8-17.2] and 14.6 [13.4-16.0] mmH, g respectively) (P = 0.239). Among ancillary observations, duration of sensory block was significantly longer for group P versus group H (133.6 ± 24.2 and 103 ± 23.4 mins; P < 0.000). However, the maximum levels of sensory and motor block, respective times required to achieve them, as well as incidences of intraoperative hypotension and bradycardia were statistically similar between group H and group P (P > 0.05). Conclusions: The IAP was raised to the level of conventionally defined intra-abdominal hypertension (>12 mmHg) in patients scheduled for elective cesarean section. However, despite being increased, the IAPprespinal or IAPpostspinal did not show any significant association with the maximum level of sensory block (P > 0.05). [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 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]

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: Intra-thecal anaesthesia is the commonly preferred, block for surgeries of lower abdomen, perineal and lower limb. It is easy to administer and very economical but needs skills. Intrathecal use of local anaesthetics possesses a short duration of action and needs early use of rescue analgesia postoperatively. Objective was to assess the efficacy of Dexmedetomidine in adjuvant with bupivacaine for neuraxial anaesthesia and postoperative analgesic characteristics. It was a prospective comparative study, conducted at Anaesthesia Department, Liaquat National Hospital, Karachi from January to July 2020. Methods: Overall 100 patients conveniently recruited who underwent lower abdominal procedures were allocated into two groups by randomization, i.e., 50 in each group and were labelled as Group N and Group D10. Group N consist of 0.5% bupivacaine 10 mg (2 ml) + diluted with 0.5ml normal saline dilution and group D10 consist of 10 μg Dexmedetomidine + 0.5% bupivacaine 10 mg (2 ml) with 0.5 ml normal saline dilution, total 2.5 ml dose in each group. The duration of block and regression was evaluated. Results: The study showed significant differences in sensory and motor block to reach T10 and Bromage 3 respectively. Patients who were assigned in Group D reported short onset of sensory to reach T10 (5.4±1.17) and motor to reach Bromage 3 (10.4±1.03) as compared to Group N (9.9±2.12 and 17±22) respectively. Participants of Group D required rescue analgesia in less amount throughout intervals as compare to group N. Conclusion: The usage of 10ug Dexmedetomidine adjuvant with 0.5% bupivacaine significantly reduced the onset on sensory T10 and motor Bromage 3 and also prolong duration of sensory and motor regression, moreover minimal adverse effects and less use of rescue analgesic drugs were observed. [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-value0.05) 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.

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 Anaesthetic (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 sensory-motor 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 18-60 years, posted for upper limb surgeries with American Society of Anaesthesiologists (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 22.0. 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.

Opioids analgesics have been used commonly among several patients in labour in various studies but side effects associated with use of opioids during painless delivery are the main factors that affect rapid postpartum recovery. Opioid use can result in risk of respiratory depression in the patient and can also disrupt the baby’s breathing and heart rate. So, the non opioid analgesic dexmedetomidine, a new alpha-2-adrenergic agonist came into existence, was evaluated and used intrathecally among parturients as an alternative adjuvant. The aim of the present review article was to establish the effect of non opioid analgesic dexmedetomidine, to assess the potency and the safety of dexmedetomidine when given intrathecally as an adjuvant to neuraxial block among patients in labour. Studies report that addition of dexmedetomidine improves the quality of the block, causes an early onset and better length of the sensory block, enhances the onset and duration of the motor block, as well as the onset of analgesia. Additionally, this lengthens the time needed to restore analgesia. Use of dexmedetomidine in combination with bupivacaine significantly prolonges the sensory block time in pregnant women.

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.

BackgroundReducing adverse effects during cesarean delivery and improving the quality of sensory blocks with appropriate doses of intrathecal hyperbaric bupivacaine can play an important role in the safe management of cesarean delivery. The aim of this study was to compare the doses of 10 and 12 mg of intrathecal hyperbaric bupivacaine 0.5% on sensory block level after first spinal failure in cesarean section (CS).MethodsIn this double-blind, randomized clinical trial, 40 candidates of CS after first spinal failure with class I-II based on American Society of Anesthesiologists (ASA) were randomly assigned into two equal groups (n = 20). Group A and B received the spinal anesthesia with 10 mg and 12 mg of hyperbaric bupivacaine (0.5%), respectively. Maximum levels of sensory block, motor block quality, and vital signs were measured in two groups by 60 min after SPA. Incidence of SPA complications during surgery were also recorded. Data were analyzed by SPSS ver.21 software using repeated measures analysis of variance at 95% confidence interval (CI) level.ResultsExcellent quality of sensory blocks and complete quality of motor blocks were achieved in all participants (100%). However, the mean time to onset of anesthesia (4.47 ± 0.69 vs. 3.38 ± 0.47, P < 0.001) and time to reach T10 level (60.73 ± 11.92 vs. 79.00 ± 19.21, P < 0.001) in the Group A, were significantly shorter than in the patients of Group B. The incidence of hypotension (P = 0.001), nausea/vomiting (P = 0.007) and bradycardia (P = 0.012) as well as administration of ephedrine and atropine were significantly higher in Group B compared to Group A.ConclusionSpinal anesthesia can be safely repeated with a 10 mg of hyperbaric bupivacaine 0.5% in a caesarean section after the initial spinal failure.Clinical trial registration[https://en.irct.ir/trial/40714], identifier [IRCT20120915010841N20].

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

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

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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

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

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]

Aims: The current study aimed at comparing arm and forearm double tourniquet in terms of the onset and duration of analgesia, tourniquet pain, and the return of sensation and movement in distal upper extremity surgery. Methods: This double-blind clinical trial was performed on 70 patients who were candidates for distal upper extremity orthopedic surgeries. The patients were randomized into two groups of arm and forearm double tourniquet. The onset time and duration of sensory and motor blocks were recorded. The pain level was recorded by visual Analog Scale (VAS) after inflating the tourniquet every 15 min till the end of operation at 15, 30, and 45 min as well as every 30 min for 2 h (at 30, 60, 90, and 120 min.) and at 6, 12, and 24 h after deflating the tourniquet. SPSS version 20 was used to analyze the data. Results: During 8–24 h after the surgery, the pain in arm double- tourniquet group was less than that in the other group (P < 0.05). There was no statistically significant difference in the time to onset of sensory–motor block between the two groups (P > 0.05). The duration of sensory block in arm double tourniquet was longer than that in forearm double tourniquet group (P = 0.002). In addition, the duration of motor block in arm double tourniquet was also longer than that in forearm double tourniquet group (P = 0.001). The pain level was equal in both the groups at all times except for the time interval of 8–24 h after the operation in arm double tourniquet group. Furthermore, there was no statistically significant difference in the pain level, and the time to onset of sensory–motor block was the same in both the groups as well. However, the duration of sensory–motor block was longer in the arm double tourniquet group, while no complication was found in either group. Conclusion: Both the techniques are applicable in hand and distal upper extremity surgeries provided that the surgical duration is not too long. Using forearm double tourniquet technique is preferable to arm double tourniquet, but the surgical duration should not exceed 60 min. That is because less amount of anesthetic drugs is needed in forearm double tourniquet technique, hence leading to a decrease in the potential side effects.

BackgroundSpinal anesthesia (SPA) is the most common type of anesthesia administered for cesarean section. The main aim of this study was to evaluate the effect of aspiration of CSF (0.2 mL) immediately after SPA with hyperbaric 0.5% bupivacaine on the extent of sensory and motor block.MethodsIn this clinical trial, 60 women at ≥37 weeks of gestation and aged between 18 and 46 years, candidate for cesarean delivery under spinal anesthesia were randomly allocated into two equal groups (n = 30). Group A (CSF-aspiration group) received the spinal anesthesia with 10 mg of hyperbaric 0.5% bupivacaine with aspiration of 0.2 ml of CSF. Group B (no-CSF-aspiration group) received only 10 mg of 0.5% hyperbaric bupivacaine. Pin-prick analgesia and motor block were tested during the induction.ResultsThe mean maximum level of analgesia was T6 in each group. Although the mean time to reach the maximum level of anesthesia (4.43 ± 5.14 vs. 2.76 ± 2.04, P = 0.107) and to reach T10 level (50.56 ± 11.51 vs. 49.10 ± 13.68, P = 0.665) in the CSF-aspiration group is longer than the non-CSF-aspiration group, but this differences were not significant. There were no significant between-group differences regarding sensory and motor block quality (P = 0.389) or failed SPA (four cases in CSF-aspiration group vs. two cases in no-CSF-aspiration group, P = 0.389). The incidence of bradycardia, hypotension, headache, vomiting and nausea were similar in both groups (P > 0.05). In addition, the difference in hemodynamic parameters between the two groups over times was not statistically significant.ConclusionOur finding indicated that the aspiration of 0.2 ml of CSF after injection of spinal anesthesia with hyperbaric 0.5% bupivacaine does not seem to affect the extent of sensory and motor block, success rate, or outcome after SPA in cesarean section.Clinical Trial Registration[https://www.irct.ir/search/result?query=IRCT20120915010841N25], identifier [IRCT20120915010841N25].

Background: Certain anthropometric measurements that are practically obtainable explain the variability in the spread of spinal anesthesia. These are useful for quick assessment of the spread of spinal anesthesia to avoid the risk of high block and also the inadequate level of block. Aims: The study aims to evaluate the effect of hip/shoulder-width ratio (HSR) on the sensory level of spinal anesthesia. Settings and Design: This prospective observational study was undertaken at a tertiary care hospital. Statistical Analysis: Pearson's correlation and multiple linear regression analyses were used to analyze the relationship between study variables with the level of sensory block. Materials and Methods: One hundred patients undergoing various surgical procedures were enrolled for the study. With a patient in a sitting position, hip-width was measured between the two iliac crests, shoulder-width was measured between two acromion processes, and vertebral column length was noted by measuring the distance from C7 vertebra to sacral hiatus. 3 mL of 0.5% hyperbaric bupivacaine was administered intrathecally at L3–L4 with 25G Quincke's needle in the lateral position. Assessment of block level was done by loss of cold sensation and loss of pinprick sensation every 5 min till 30 min. The numbers of segments blocked were noted from the S5 segment. The relationship between various factors with the level of sensory block was analyzed by the Pearson's correlation coefficient. Results: HSR and body mass index (BMI) have a significant correlation with the sensory level of spinal anaesthesia, HSR (r = 0.297, P < 0.05) and BMI (r =0.385, P < 0.05). Conclusion: HSR can help predict the cephalad spread of spinal anesthesia. We can expect a higher level of sensory blockade of spinal anesthesia in females who generally have an HSR more than one. [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]

Background & Aim: The temperature of a local anaesthetic solution influences its pKa and molecular kinetic activity, thereby affecting baricity. We evaluated the effects of 0.5% Levobupivacaine preheated at 37°C on sensory and motor block characteristics and haemodynamic in patients undergoing infra-umbilical surgeries. Methods: This was a prospective, randomised, double blinded study, in which 70 patients were allocated into two groups [Group A (n=35) and Group B (n=35)]. In Group A, patients were administered 3 mL of levobupivacaine 0.5% solution at room temperature (24 -28°C) and patients in Group B were administered with 3 mL of levobupivacaine 0.5% solution at 37°C (Thermostatically controlled digitalized hot bath machine) into the subarachnoid space. Our primary objective was to determine the time of onset of sensory blockade at T10. Time of onset and duration of motor blockade, duration of analgesia, time to two segment regression and other adverse events after spinal anaesthesia were secondary objectives. Results: The time to reach a sensory block of T10 was significantly shorter in group B (Mean °SD 2.7±2.9 min, P 0.005) compared to that in group A (Mean±SD 4.8±4.5 min). The mean duration of sensory block was longer in group B (Mean±SD 155.5±25.9 min, P 0.048). Time to onset of motor block, duration of motor block and time to regression of two dermatomal level were not found statistically significant among the two groups. Conclusion: Spinal anaesthesia with 0.5% levobupivacaine heated to 37°C shortens sensory block onset time and provides longer block duration. [ABSTRACT FROM AUTHOR]

To evaluate the effects of dexmedetomidine administered perineurally or intramuscularly (IM) on sensory, motor function and postoperative analgesia produced by lidocaine for sciatic and femoral nerve blocks in dogs undergoing unilateral tibial tuberosity advancement surgery. Prospective, blinded, clinical study. A group of 30 dogs. Dogs were anaesthetized with acepromazine, propofol and isoflurane in oxygen/air. Electrolocation-guided femoral and sciatic nerve blocks were performed: group L, 0.15 mL kg–1 2% lidocaine (n = 10); group LD loc , lidocaine and 0.15 μg kg–1 dexmedetomidine perineurally (n = 10); group LD sys , lidocaine and 0.3 μg kg–1 dexmedetomidine IM (n = 10). After anaesthesia, sensory blockade was evaluated by response to forceps pinch on skin innervated by the saphenous/femoral, common fibular and tibial nerves. Motor blockade was evaluated by observing the ability to walk and proprioception. Analgesia was monitored with Short Form of Glasgow Composite Pain Scale for up to 4 hours after extubation. Methadone IM was administered as rescue analgesia. Data were analysed by linear mixed effect models and Kaplan-Meier test (p < 0.05). Median duration of the sensory blockade for all nerves was longer (p < 0.001) for group LD loc than for groups L and LD sys and was longer (p = 0.0011) for group LD sys than for group L. Proprioception returned later (p < 0.001) for group LD loc [285 (221–328) minutes] compared with group L [160 (134–179) minutes] or LD sys [195 (162–257) minutes]. Return of the ability to walk was similar among all groups. Dogs in group LD loc required postoperative rescue analgesia later (p = 0.001) than dogs in groups LD sys and L. Dexmedetomidine administered perineurally with lidocaine prolonged sensory blockade and analgesia during the immediate postoperative period. Systemic dexmedetomidine also prolonged the sensory blockade of perineural lidocaine. [ABSTRACT FROM AUTHOR]

Background and Aims: Subarachnoid block is the most commonly used anaesthesia technique for lower limb surgeries. Opioids are the most commonly used adjuvants with local anesthetics (LA). Adjuvants are given premixed with LA loaded in a single syringe. This study was conducted to evaluate differences in level of sensory and motor block and incidence of hypotension whilst administering hyperbaric bupivacaine and fentanyl either in a single syringe or different syringes. The effect of administering opioid prior to LA and vice versa on these parameters was also assessed. Methods: One hundred and twenty patients were randomly allocated into three groups of 40 each: Group A received premixed 0.5% heavy bupivacaine 2.5 ml (12.5 mg) and 0.5 ml (25 microgram) of fentanyl in a single 3.0 ml syringe, Group B received 0.5 ml (25 microgram) of fentanyl in a 3.0 ml syringe followed by 0.5% heavy bupivacaine 2.5 ml (12.5 mg) in a 3.0 ml syringe, Group C received 0.5% heavy bupivacaine 2.5 ml (12.5 mg) in a 3.0 ml syringe followed by 0.5 ml (25 microgram) fentanyl in a 3.0 ml syringe. All statistical calculations were done using SPSS 21 version statistical program for Microsoft Windows. Results: The mean time for onset of sensory and motor block was least in group C followed by group B. The duration of sensory and motor block was prolonged in groups B and C. Patients in group A experienced more hypotension as compared to groups B and C. Conclusion: Administering hyperbaric bupivacaine first followed by fentanyl leads to an early onset and prolonged duration of sensory and motor block.

Aim: This study aims to assess the anaesthetic effects of adjuvant therapies with neostigmine or magnesium sulphate compared with bupivacaine intrathecally, alone in patients undergoing infraumbilical surgeries under subarachnoid block. Materials and Methods: After approval from the Institutional Ethics Committee and informed written consent from patients, the present study was carried out in 90 patients of ASA Class I and II, aged between 18 and 50 years, of either sex (M and F), scheduled for elective infraumbilical surgeries. The selected patients were randomly divided into three equal groups of 30 patients. Group I patients received bupivacaine heavy (0.5%) 3 ml (15 mg) +0.5 ml normal saline. Group II patients received bupivacaine 3 ml (5 mg) with preservative-free magnesium sulphate 0.5 ml (50 mg). Group III patients received bupivacaine (3 ml) with neostigmine 0.5 ml (25 μg). The parameters assessed were the duration of sensory and motor blockade, quality of block, perioperative haemodynamic effects and duration of post-operative analgesia. Results: Addition of 50 mg of magnesium sulphate significantly increases the duration of sensory block in Group II (397.67 ± 14.003) as compared to Group III (188.67 ± 23.887) and Group I (183.10 ± 8.185), duration of motor block in Group II (213.67 ± 13.767) as compared to Group III (164.67 ± 23.154) and Group I (177.30 ± 7.312), duration of analgesia in Group II (349.00 ± 22.453) as compared to Group III (327.83 ± 31.61) and Group I (241.33 ± 16.399). Haemodynamic parameters were stable in both Groups I and II. Quality of block was much better in Group II (3.83 ± 0.40) as compared to Group III (3.49 ± 0.68) and Group I (2.83 ± 0.79). Conclusion: According to the results obtained from the present study, it is concluded that addition of 50 mg of magnesium sulphate as an adjuvant to intrathecal bupivacaine is better in view of the duration of sensory and motor blockade, quality of block and duration of analgesia (requirement of rescue analgesia) without any significant increase in adverse effects.