Background: Subarachnoid block is commonest anaesthetic technique used for most gynaecological surgeries. Local anaesthetic agents have traditionally been used for this, but with the discovery of opioid receptors in spinal cord in substantia gelatinosa. Possibility of synergism between opioids & local anaesthetics co-administered intrathecally has been explored for various lower abdominal surgeries.
Aims & Objective:To study was to compare effect of intrathecal bupivacaine with bupivacaine, fentanyl mixture to assess safety and efficacy, peri -operative hemodynamic stability postoperative pain relief in major gynecological surgeries. Materials and Methods: 60 female patients with American society of anaesthesiologists (ASA) grade I OR II were divided in two groups after matching. Group BF received inj. Bupivacaine 15 mg (0.5%) 3 ml + inj. Fentanyl 25 mcg, (50 mcg/ml), 0.5 ml and Group B: (inj. Bupivacaine 15 mg (0.5%) 3 ml + Normal Saline (0.5 ml), total volume was 3.5 ml in each group. Spinal anaesthesia was given with conventional technique. Results: Duration of sensory block and effective analgesia was prolonged while there was no change in duration of motor block with intrathecally bupivacaine with fentanyl as compared to inj. Bupivacaine alone. Conclusion: Intrathecal Fentanyl as an adjuvant to bupivacaine improves quality of block with longer duration of sensory block & prolongs duration of effective analgesia.
Thoracic epidural anaesthesia (TEA) reduces cardiac and splanchnic sympathetic activity and thereby influences perioperative function of vital organ systems. A recent meta-analysis suggested that TEA decreased postoperative cardiac morbidity and mortality. Objective is to Study of Breast Surgery under Thoraco Epidural Analgesia as sole anesthetic technique. This study was conducted on 20 cooperative female patients of age group 42-55 year with ASA grade I-III. Procedure was done in either sitting or lateral position. Under full aseptic precautions 18 G epidural needle was introduced between T3-T4 or T2-T3 space after infiltration of local anesthetic agent. After confirmation of the space epidural catheter was placed and 2.5 to 3.5 cm of catheter length was kept inside. After Proper Fixation of the catheter patients were made supine. A test dose of 2 ml Xylocaine 2% with adrenalin was injected before giving proper local anesthetic dosage. Patients pulse rate, Blood pressure and respiration were noted. Inj Xylocaine 1.5% 12 ml was injected through the catheter and analgesic effects were awaited. After checking adequate blockade surgery was allowed after positioning of sand bag under operative site. From Our study we conclude that midthoracic epidural analgesia technique is a safe alternative acceptable method for various breast surgery with excellent postoperative pain relief and early recovery.
Background: Hypotension is a common complication following spinal anesthesia (SA) for lower segment cesarean section (LSCS) which has detrimental effects both on mother and fetus. This study is aimed at investigating the correlation between baseline perfusion index (PI) and incidence of hypotension following SA for parturients undergoing LSCS. Methods: 60 parturients were divided into two groups of 30 patients each on the basis of baseline PI. Parturients with baseline PI ≤3.5 and >3.5 were added in Group I and Group II respectively. SA was performed with 2ml (10 mg) of injection 0.5% hyperbaric bupivacaine at L3-L4 or L2-L3 inter-space. Hypotension was defined when the mean arterial pressure falls below 65 mmHg which was treated with IV fluid boluses and vasopressors. Results: There was no significant correlation between baseline PI (>3.5 and ≤3.5) and incidence and severity of hypotension (p > 0.05).
Conclusion:Parturients with baseline PI > 3.5 were not at higher risk of developing hypotension following spinal anesthesia compared to those with baseline PI ≤ 3.5.
Background: Epidural analgesia is the most commonly used method for labour analgesia. Aims & Objective: To evaluate the safe dose of fentanyl added to Bupivacaine 0.125% and its effect on quality and duration of analgesia with side-effects. Materials and Methods: Forty-five healthy nulliparous women, ASA physical status I and II with an uncomplicated pregnancy and single fetus in vertex position were given lumbar epidural analgesia. Patients in Group A (n=15) received Bupivacaine 0.125 percent; Group B (n=15) and C (n=15) received the same agents as Group A but with addition to the initial dose of 2 mcg/ml or 4 mcg/ml of fentanyl respectively. All the patients were evaluated for duration and quality of analgesia, duration of labour, method of delivery and side effects. Results: Addition of either 2 mcg/ml or 4mcg/ml of fentanyl resulted in longer duration of analgesia (132.2 ± 12.4 minutes and 188.20 ± 18.5 minutes respectively versus 92.5 ± 10.2 minutes) and also decreased number of top up doses significantly. Quality of analgesia was better in Group B and Group C as compared to Group A. Addition of fentanyl did not affect the duration of labour, the method of delivery and fetal outcome. Conclusion: Combination of Fentanyl 2 mcg/ml and Fentanyl 4 mcg/ml with Bupivacaine 0.125% is both and safe for providing labour analgesia via epidural route.
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