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Background: Recent trends in surgical practice involve using local anesthesia for procedures like middle ear tympanoplasty due to its benefits, but patients often experience discomfort. Researchers are investigating alpha-2 agonists like clonidine and dexmedetomidine to enhance pain relief. We conducted a double-blind study comparing dexmedetomidine and clonidine’s effectiveness in extending pain relief after tympanoplasty using local infiltration. Aim and Objective: In light of this context, we undertook a randomized, double-blind investigation to compare the efficacy of dexmedetomidine and clonidine in extending the duration of pain relief via local infiltration for tympanoplasty. Materials and Methods: This prospective, randomized, double-blind study was conducted on total of 60 patients belonging to the American Society of Anesthesiologists Class I and II scheduled for tympanoplasty under local anesthesia. All patients were divided into two groups: Group LC, received local infiltration with 12 mL of lignocaine (2%) with adrenaline (1:200,000) plus clonidine (1 μg/kg) and Group LD, received local infiltration with 12 mL of lignocaine (2%) with adrenaline (1:200,000) plus dexmedetomidine (1 μg/kg). Results: Both the groups were comparable regarding demographic profile, perioperative hemodynamics, and total duration of surgery. Time of onset of analgesia was faster in Group LD (89.53 ± 5.54 vs. 94.17 ± 6.19 s) (P = 0.0034) and total duration of analgesia was also prolonged in Group LD (562.40 ± 24.82 vs. 332.30 ± 12.39 min) (P < 0.0001). Conclusion: We concluded that in comparison to clonidine, dexmedetomidine is more effective in terms of faster onset and prolongation of total duration of analgesia when used with local infiltration anesthesia.

Background: Laryngoscopy and orotracheal intubation often trigger a hemodynamic response, increasing catecholamines and potentially leading to higher morbidity. Fentanyl, with a high safety margin and rapid onset, and Nalbuphine, a µ receptor antagonist and k receptor agonist with minimal respiratory depression and a “ceiling effect,” are commonly used to mitigate this response. Aim: This study compares the efficacy of Fentanyl and Nalbuphine in reducing the pressor response during laryngoscopy and intubation in patients under general anesthesia, monitored by Bispectral Index (BIS). It also evaluates total analgesic requirements, time to first rescue analgesic post-extubation (VAS score), and associated complications. Method: The study was a hospital-based, prospective, double-blind, randomized interventional trial registered under the Clinical Trials Registry - India (CTRI/2022/05/042731). The sample size of 70 patients (35 in each group) was calculated based on alpha error, study power, and the minimum clinically significant difference for MAP after induction. Patients aged 18-65 years with ASA grade I and II and body weight between 40-70 kg were included. Group A received Fentanyl, and Group B received Nalbuphine. Vital parameters were monitored during the surgery, and additional doses of the study drug were administered if the BIS score exceeded 60. Postoperative analgesic effect was evaluated by a blinded anesthesiologist. Results: The demographic characteristics of the study population were similar between the Fentanyl and Nalbuphine groups, as indicated by age, weight, sex, and ASA physical status, there was a statistically significant difference in systolic blood pressure, diastolic blood pressure, mean arterial pressure and heart rate post-intubation, with the Nalbuphine group demonstrating a greater increase compared to the Fentanyl group, which was significant at all time intervals.

Background and Aims: Brachial plexus block is a widely used approach for upper limb surgeries as an alternative to general anesthesia to achieve ideal operating conditions by providing adequate muscle relaxation and maintaining intraoperative hemodynamic stability. Ultrasound-guided supraclavicular brachial plexus block provides intraoperative anesthesia and postoperative analgesia. It reduces many complications such as intravascular injection pneumothorax. Levobupivacaine is preferable over bupivacaine due to its lower cardiotoxicity, prolonged sensory block, and shorter duration of motor block. Materials and Methods: A prospective, hospital-based, double-blinded, randomized, controlled, comparative study was planned on 80 adult patients of either sex belonging to the American Society of Anesthesiologists Class 1 and 2 undergoing upper limb orthopedic surgeries. Group L – 24 mL levobupivacaine 0.375% (90 mg) + NS (1 mL) (total volume 25 mL) and Group LN – 24 mL levobupivacaine 0.375% (90 mg) +5 mg nalbuphine diluted with NS to 1 mL volume (total volume 25 mL). Duration of analgesia, onset, and duration of sensory block and motor block, hemodynamic changes, and total doses of rescue analgesia in 24 h were noted in both groups. Results: The duration of analgesia was significantly longer in Group LN (749.80 ± 9.70 min) as compared to Group L (641.20 ± 12.71 min) (P < 0.001). Onset of sensory block in Group LN (11.15 ± 0.83 min) is faster than in Group L is (13.30 ± 0.52 min) (P < 0.001). Onset of motor block in Group LN (13.68 ± 0.73 min) is faster than in Group L (16.33 ± 0.89 min) (P < 0.001). Hemodynamic parameters were comparable in both groups. There was no significant difference in adverse effects and complications. Conclusion: The addition of nalbuphine to levobupivacaine provides a longer duration of analgesia as compared to levobupivacaine alone.

Background and Aims: Subarachnoid block is the most preferred anesthetic technique for infraumbilical surgeries as it provides better postoperative analgesia, effective muscle relaxation, and cost-effectiveness. Levobupivacaine is preferable over bupivacaine due to its lower cardiotoxicity, prolonged sensory block, and shorter duration of motor block. Opioids as an adjuvant to intrathecal local anesthetics enhance the quality of both analgesia and anesthesia during intraoperative as well as postoperative period. The present study aimed to compare levobupivacaine with and without fentanyl in spinal anesthesia. Methods: In this prospective, randomized, double-blinded study, a total of 80 patients belonging to the American Society of Anesthesiologists Physical Status I and II were enrolled for infraumbilical surgeries. Patients were randomly allocated into two groups. Group Levobupivacaine (L) (n = 40) received isobaric levobupivacaine 0.5% 2.5 ml with 0.5 ml normal saline and Group Levobupivacaine + fentanyl (LF) (n = 40) received isobaric levobupivacaine 0.5% 2.5 ml with fentanyl 25 μg (0.5 ml). Time of onset and duration of both sensory and motor block, Visual Analog Scale score, duration of analgesia, hemodynamic changes, and any adverse events were noted in both the groups. Results: The onset of both sensory and motor block was significantly faster in Group LF (P < 0.05). The duration of sensory block was significantly longer in Group LF (P < 0.05). The duration of motor block was found to be comparable between two groups with stable hemodynamics and no perioperative sedation (P > 0.05). The duration of analgesia was significantly longer in Group LF (336.5 ± 31.3 min) compared to Group L (223.65 ± 32.17 min) P < 0.001. Conclusion: Intrathecal fentanyl (25 μg) can be effectively used as an adjuvant to isobaric 0.5% levobupivacaine as it provides better block characteristics with minimal adverse effects in patients undergoing infraumbilical surgeries.

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

Context: Ultrasound-guided supraclavicular brachial plexus block is ideal for upper limb surgical procedures. Buprenorphine used as an adjuvant to ropivacaine may prolong analgesia. Aims: The aim is to assess the analgesic efficacy and safety of buprenorphine added to 0.5% ropivacaine solution. Settings and Design: This prospective, double-blind, randomized study was conducted on 60 adult patients of the American Society of Anesthesiologists physical Status I and II undergoing various upper limb surgeries under ultrasound-guided supraclavicular brachial plexus block. Subjects and Methods: Patients were allocated into two groups of 30 each to receive either 30 ml 0.5% ropivacaine with 1 ml buprenorphine (0.3 mg) (Group B) or 30 ml 0.5% ropivacaine with 1 ml normal saline (Group C) for supraclavicular brachial plexus block. Onset, duration, and quality of sensory block and motor block; duration of analgesia and side effects were observed. Results: The mean duration of analgesia was significantly longer in Group B (868.2 ± 77.78 min) than in Group C (439.3 ± 51.19 min). The mean duration of motor and sensory block were significantly longer in Group B (451.8 ± 57.18 min) and (525.8 ± 50 min), respectively, than in Group C (320.5 ± 43.62 min) and (373 ± 53.78 min), respectively (P < 0.05). Conclusions: Addition of buprenorphine to ropivacaine for ultrasound-guided supraclavicular brachial plexus block prolonged the duration of sensory and motor blockade and postoperative analgesia without an increase in side effects.