Search

Introduction: Subarachnoid block, although being highly efficient with lesser drug doses, often has limitation such as hypotension, continues to be a matter of concern to the anesthetist. The present study was aimed to compare the use of phenylephrine, ephedrine, and mephentermine bolus for maintenance of blood pressure during spinal anesthesia in lower abdominal surgeries. Subjects and Methods: In a randomized, prospective study, 90 adult patients of either sex who developed hypotension during surgery under subarachnoid block were allocated into three groups to receive bolus phenylephrine, ephedrine, and mephentermine. The number of boluses and time taken to recover from hypotension was noted. Occurrence of adverse effects in the perioperative and postoperative period was also noted. Results: Results were analyzed by Student's paired t-test and Chi-square test. The ANOVA test was used to compare the group variances among the study groups. P < 0.05 was considered statistically significant. Thirty-four hypotensive events (average 1.03 events/patient) took place in mephentermine group. In phenylephrine group, a total of 53 hypotensive events took place. On an average, the group had a total of 1.61 hypotensive events per patient. No hypotensive event took place in ephedrine group after the first bolus of drug (average 1 event/patient). Mean heart rate in phenylephrine group was significantly lower as compared to the other two groups (P < 0.001). Conclusion: Mephentermine and ephedrine were similar in performance, offered a better hypotensive control, and had lower recurring events as compared to phenylephrine.

Background: Epidural anesthesia has been well established as a safe and effective technique not only for perioperative anesthesia but also for postoperative analgesia. Various adjuvants have been added to local anesthetic agent in an effort to prolong this duration. Aims: The aim of this study was to compare and evaluate the anesthesia and analgesic property of ropivacaine to its combination with clonidine for lower limb orthopedic surgery under epidural. Materials and Methods: In a prospective, randomized, double-blind study, eighty adult patients undergoing lower limb surgeries received either 0.75% ropivacaine or 75 μg clonidine with 0.75% ropivacaine through epidural route. Patients were compared for hemodynamic variability, quality of motor and sensory block, intra- and post-operative analgesia, and the side effects associated. Statistical Analysis: Data analysis was done by Student's paired t-test, Chi-square test, and Mann–Whitney test. P < 0.05 was considered statistically significant. Results: The time taken for onset of the motor as well as the sensory block was significantly shorter in ropivacaine with clonidine group as compared to ropivacaine alone group. Mean duration of analgesia was significantly higher in patients who received clonidine as an adjunct (P < 0.001). There was no significant difference observed in the incidence of hemodynamic changes or side effects. Conclusion: The study demonstrated that use of clonidine as an adjuvant to ropivacaine through epidural route provides a hemodynamically stable, faster, and prolonged epidural block and a longer analgesic effect as compared to ropivacaine alone.

Introduction Ropivacaine has been studied previously and holds promise as an agent that offers a safe, efficacious, and better recovery profile than other conventional agents such as bupivacaine. The aim of the present study was to compare the safety and efficacy of equal volume of different concentration of ropivacaine for epidural analgesia in patients undergoing major lower limb orthopedic surgery. Subjects and methods One hundred and fifty adult patients were randomized into three groups to receive single dose of equal volume of ropivacaine through epidural route in concentrations of 0.2%, 0.5%, and 0.75%, respectively. All the groups received equal dose of ropivacaine of same concentration for subarachnoid block using combined spinal-epidural technique. Results Modified Bromage Scale and Numeric rating scale was used to assess motor block and analgesia. Data analysis was done using WINDOW SPSS Student Version 17 ANOVA test. Student's t-test was performed for comparison between two groups, and qualitative data were analyzed by applying Chi-square test. Conclusion 0.5% and 0.75% ropivacaine were sufficient and effective for intrathecal subarachnoid block as well as for postoperative analgesia with epidural use. Shorter duration of motor blockade and analgesia was seen with ropivacaine 0.2%.