Search

Background and aim: An accurate placement of spinal needle is crucial while injecting drugs to avoid a failed sub arachnoid block (SAB). A pre puncture estimation of skin to subarachnoid depth (SSD) may guide accurate spinal needle placement. This study is aimed to predict the depth from skin to subarachnoid space based on pre-operative anthropometric assessment and to find out formula for predicting SSD, best suited in terms of accuracy when compared with observed depth. Method: In this hospital based, prospective, observational study, a total of 120 patients, of which 68 were men, and 52 were women (non-pregnant) with a mean age of 59.75 ±14.1 kilograms. The SSD was measured after SAB was performed. This SSD was compared with the predicted SSD calculated using the Abe’s, Bonadio’s, Craig’s, Stocker’s, and Chong’s modified formulae. Analysis was done using unpaired t test for quantitative data to determine best suited formula to predict SSD in our population in terms of both accuracy and ease of application. Pearson correlation test was also done. Results: The observed SSD in the overall study population was 4.96 ± 0.67 cm. Stocker’s formula is closest with a mean difference of 0.17cm. In males the mean observed depth was (5.06±0.60 cm) more than that in the non-pregnant female population (4.83±0.74cm). These anthropometric variables were statistically significant with a presentation value of

Background: To investigate the onset and duration of sensory and motor blockade in isobaric 0.75% Ropivacaine and isobaric 0.75% Ropivacaine - Clonidine in patients undergoing infra umbilical surgeries. One year double-blinded randomized controlled trial. Methods: A total of 70 patients undergoing infra umbilical surgeries were allocated into two groups namely, Group I (n=35; Patients received 3 ml of isobaric 0.75 % ropivacaine intrathecally) or Group II (n=35; Patients received 3 ml of isobaric 0.75 % ropivacaine + 15 mcg of clonidine intrathecally). Onset and duration of Sensory and motor block and hemodynamic parameters were noted and compared. Results: The demographic parameters were comparable in both groups. The onset of sensory block was similar in both groups but the duration of sensory block was prolonged in group II (191.7±19.21 minutes) than in group I (180.8 ±13.08 minutes). The motor block onset was faster in group II (11.4±2.29 minutes) than in group I (13.6±2.29 minutes). Duration of motor block was prolonged in group II (271.3±18.32 minutes) than in group I (224.5±16.46 minutes). Conclusion: The addition of clonidine to 0.75 % isobaric ropivacaine intrathecally prolonged the duration of sensory and motor block but with no effect on the sensory onset but the faster onset of the motor block with no significant hemodynamic changes.

Introduction: Pain, an inherently subjective experience, plays a pivotal role in the body's defence mechanism by signalling tissue damage or potential harm. Thus, optimal postoperative pain management is a cornerstone of modern surgical practice, essential for improving recovery outcomes and overall patient well-being., Methods: In this study, a total of 60 patients were randomly assigned to two groups of 30 each: Group C (clonidine) and Group G (gabapentin). Group C received oral clonidine 100 mcg and Group G received oral gabapentin 600 mg one hour prior to the subarachnoid block. Duration of sensory and motor block, hemodynamic parameters, Visual Analog Scale (VAS) scores, time to rescue analgesia and any side effect of both drugs were assessed in both groups., Results: The duration of motor and sensory blockade, as well as intraoperative hemodynamics and respiratory rates, were comparable between the two groups. Group G exhibited significantly lower VAS scores from 150 minutes postoperatively up to 12 hours (p < 0.001). Additionally, Group G experienced longer duration of postoperative analgesia (16.8±3.9 hours) compared to Group C (9.27±1.7 hours). About 26.6% of the patients in Group C and 6.7% of the patients in Group G presented with postoperative nausea and vomiting (PONV)., Conclusion: Oral gabapentin at a dosage of 600 mg demonstrates superior efficacy as a premedication compared to oral clonidine 100 mcg for patients undergoing lower abdominal and lower limb surgeries under spinal anesthesia. Group G demonstrated extended postoperative analgesia, lower VAS scores, and a reduced incidence of PONV, indicating its superiority over clonidine as an analgesic adjunct., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Research and Recognition Committee, Dr. D.Y. Patil Medical College, Hospital and Research Centre issued approval IESC/PGS/2020/150. Clinical Trials Registry – India (CTRI) clearance is CTRI/2021/11/038110. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Bagle et al.)

Aim: To assess the effectiveness of multimedia based educational video shown preoperatively to cancer patients posted for surgery in alleviating anxiety associated with spinal anaesthesia/sub arachnoid block. Materials and Methods: This was a randomised controlled trial conducted on a total of 200 patients posted for oncological procedure in Department of Anaesthesiology and Pain relief, Kidwai Memorial Institute of Oncology, Bengaluru, India. the total subjects included were randomised into two groups: Video group, where a short educational video depicting procedure of spinal anaesthesia was shown preoperatively to the patients and non video group (control group) where no video was shown. Anxiety using Visual Analogue Scale (VAS) and haemodynamic parameters like Heart Rate (HR), Mean Arterial Pressure (MAP), Systolic blood Pressure (SBP), Diastolic blood pressure (DBP) were assessed pre and post intervention in both groups. Categorical data were compared using chi-square test. Student's unpaired t-test was used for inter-group comparison. The p-value <0.05 was considered statistically significant. Results: Out of total 200 patients (93 males and 107 females; 18-60 years of age) enrolled in the study, 100 patients were categorised in video group (41.53±11.60 years) and remaining 100 were included in non video group (42.92±11.63 years). There was no statistically significant difference in the mean anxiety score and haemodynamic parameters at the baseline for both the groups. Post intervention, the video group showed a greater reduction in anxiety than the control group (intra-group reduction: 1.84±1.20 vs 1.42±1.18), and the difference was statistically significant (p-value=0.013). Mean HR was significantly higher in the control group (84.66±13.22, 80.46±13.11 and 79.44±14.05 at 5, 10 and 15 min, respectively) when compared with the video group (81.75±11.49, 77.35±12.59 and 74.82±13.05 at 5, 10 and 15 min, respectively). Similarly, SBP, DBP & MAP were noted significantly higher in the control group compared to the video group (p-value <0.001). Conclusion: Multimedia-based educational video depicting technique of spinal anaesthesia/sub arachnoid block significantly reduces anxiety and associated haemodynamic variations. Showing short video clip about spinal anaesthesia technique is an easy way for transfer of information about anaesthesia for patients and allows time for patients to reflect on this preoperatively and thereby reduces their anxiety. [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.

Introduction: Most of the patients posted for surgery experience anxiety and this is more pronounced in cancer patients posted for oncological surgery. The majority of it arises from apprehension stemming from a lack of understanding of anaesthetic procedures and surgery. Aim: To assess the effectiveness of multimedia-based educational video shown preoperatively to cancer patients posted for surgery in alleviating anxiety associated with spinal anaesthesia/sub arachnoid block. Materials and Methods: This was a randomised controlled trial conducted on a total of 200 patients posted for oncological procedure in Department of Anaesthesiology and Pain relief, Kidwai Memorial Institute of Oncology, Bengaluru, India. the total subjects included were randomised into two groups: Video group, where a short educational video depicting procedure of spinal anaesthesia was shown preoperatively to the patients and non video group (control group) where no video was shown. Anxiety using Visual Analogue Scale (VAS) and haemodynamic parameters like Heart Rate (HR), Mean Arterial Pressure (MAP), Systolic blood Pressure (SBP), Diastolic blood pressure (DBP) were assessed pre and post intervention in both groups. Categorical data were compared using Chi-square test. Student’s unpaired t-test was used for inter-group comparison. The p-value

Background and Aims: Spinal anaesthesia is the most preferred technique of anaesthesia in parturient, undergoing lower segment caesarean sections (LSCS) which provides effective pain relief during intra operative and early postoperative period. However, recent studies demonstrate that about 50%–70% of patients experience moderate to severe pain after LSCS indicating that postoperative pain remains poorly managed. The aim of our study was to compare intrathecal magnesium sulphate (Mgso4) and ketamine as adjuvants to hyperbaric bupivacaine in parturients posted for elective caesarean sections under spinal anaesthesia to determine their effectiveness in extending the duration of analgesia Materials and Methods: After institutional ethical committee approval, 82 parturient undergoing elective LSCS were enrolled into the prospective randomized double blinded study. Group BK (n = 41) received intrathecal ketamine (25 mg) as additive to hyperbaric bupivacaine and group BM (n = 41) received magnesium sulphate (75 mg) as additive to hyperbaric bupivacaine. Time of onset of sensory analgesia, motor blockade, duration of analgesia was noted down. Intraoperative hemodynamics and any adverse effects of study drugs were noted. Results: The mean duration of analgesia in group BK was significantly longer (P < 0.05) than in Group BM. The onset of sensory and motor blockade was significantly early in Group BK compared to Group BM. Hemodynamics was better maintained in Group BK with less requirement of ephedrine compared to Group BM. The visual analog scale scores were significantly lower without side effects in both the groups. Conclusion: The present study demonstrated that the duration, quality of analgesia, hemodynamic stability was better with intra thecal ketamine as an adjuvant to bupivacaine compared to intrathecal MgSo4 without any significant side effects on mother and child. [ABSTRACT FROM AUTHOR]

A Randomised Clinical Trial to Compare the Efficacy of Tramadol and Nalbuphine for Treatment of Shivering after Spinal Anaesthesia in Patients Posted for Lower Limb Orthopaedic Surgery

Introduction: Nalbuphine and tramadol are opioids which have been used to control post-anaesthetic shivering. Aim: To compare the efficacy of nalbuphine and tramadol in the treatment of post-spinal anaesthesia shivering. Materials and Methods: This was a randomised clinical trial conducted on 60 patients of either gender (20-60 years age group) from January 2019 to June 2020, American Society of Anaesthesiologists (ASA) Grade I or II, having post-spinal anaesthesia shivering. The total sample was divided into two groups of 30 patients each. Group T received injection (Inj) tramadol 1 mg/kg intravenously (iv) and Group N received Inj. nalbuphine 0.1 mg/kg iv. Grade of shivering was assessed with a five point scale as Grade 0- no shivering; Grade 1; No visible muscle activity, but one or more of piloerection, peripheral vasoconstriction or peripheral cyanosis Grade 2; Muscular activity in only one muscle group; Grade 3: Moderate muscular activity in more than one muscle group, but not generalised shaking; Grade 4: Violent muscular activity that involves the entire body. The time taken for disappearance of shivering, assessment of improvement of shivering (complete- if grade of shivering becomes 0, partial- if grade of shivering deceased but not zero), recurrence rate and side-effects such as nausea, vomiting, deep sedation were noted. Independent t-test and Chi-square test were used to analyse the data. A p-value <0.05 were considered statistically significant. Results: The time taken for disappearance of shivering was shorter in group N than T (3.20±0.96 minutes and 6.43±0.97 minutes respectively, p=0.001). Significantly better sedation (p-value 0.04) was seen in nalbuphine group as grade 3 sedation were seen in 15 patients of nalbuphine group as compared to none in tramadol group. All the patients in group N had complete improvement of shivering and there was no recurrence, while in group T six patients had partial improvement in shivering and four (13%) had recurrence. Complications such as nausea (three patients) and vomiting (one patient) were seen in Group T while none were seen in Group N. Conclusion: The efficacy of nalbuphine is greater than tramadol in controlling post-spinal anaesthesia shivering, with minimal side-effects. [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. [ABSTRACT FROM AUTHOR]

Spinal Anaesthesia is commonly used for lower extremity surgery. Hyperbaric Bupivacaine is often used for this purpose. Addition of adjuvants increase duration of Bupivacaine action. Study of the effect of Neostigmine as adjuvant to injection Bupivacaine heavy (0.5%) for spinal anaesthesia. Thirty two (32) ASA grade I & II patients aged 20-60 year were studied, they received 0.5% Bupivacaine (H) with 25-mcg Neostigmine, hemodynamic, reduction in post-operative pain up to 24 hours post operatively was assessed by visual analogue score (VAS) & side effects were studied. Over all 24-hour visual analogue score in-these patient was significantly lower (p<0.01). Neostigmine as an adjuvant had no effect on characteristic of spinal anaesthesia (p>0.05). First dose of rescue analgesia or duration of complete analgesia was longer. Incidence of bradycardia in these patients was lower(p<0.01). Incidence of nausea and vomiting was not increased. Neostigmine prolong the duration of spinal anaesthesia. Neostigmine increases the analgesic efficacy when used as adjuvant with 0.5% bupivacaine heavy. [ABSTRACT FROM AUTHOR]